Result comparison of the abdominal and vaginal approaches in vesicovaginal fistula management

Abstract

Objective: To compare the results of the surgical approach between the abdominal and vaginal techniques in simple and complex vesicovaginal fistula repair, suggesting the safest surgical approach.

Materials and methods: An analytic, cross-sectional, retrospective study with convenience sampling was conducted on females with a history of simple and complex vesicovaginal fistulas that underwent surgical repair with the abdominal or vaginal technique at the Urology Service of the Hospital General de México within the time frame of February 2015 to February 2018. After a thorough review of the medical records, the following study variables were determined: hospital stay, surgery duration, intraoperative blood loss, complications according to the Clavien classification, and the risk for refistulization. The data were analyzed using measures of central tendency and dispersion.

Results: Sixty patients that underwent simple or complex vesicovaginal fistula repair were divided into two groups according to the surgical technique employed: 30 patients with the abdominal approach and 30 patients with the vaginal approach.  Mean patient age was 42.58 ± 11.3 years and the past histories were hysterectomy due to a benign cause in 37 (62%) patients, hysterectomy due to an oncologic cause in 11 (18%) patients, childbirth in 6 (10%) patients, and infection in 6 (10%) patients. Mean fistula size determined through cystoscopy was 0.73 ± 0.52 cm. The patients that underwent transvaginal surgery had fewer complications, compared with those treated with the abdominal technique (6% vs 33%), p = 0.012.

Conclusions: Vesicovaginal fistula repair through the transvaginal approach is recommended for its reduced hospital stay, less intraoperative bleeding, shorter surgery duration, lower recurrence rate, lower complication rate, higher success rate, and faster recovery. It can be performed as a first surgical option.