Login to Access Video or Poster Abstract: MP36-10
Sources of Funding: none

Introduction

Urethrovaginal fistula (UVF) is not highly prevalent in urologic practice but merits attention. There are few large published series. This is a review of management of all patients that have been treated over a 30?year period at our institution to assess etiology, operative management, and outcomes.

Methods

Between 1986 and 2016, a total of 36 UVFs were repaired. Retrospective review recorded presentation, history, etiology, surgical approach, and results. Long?term lower urinary tract symptoms (LUTS) were noted. All UVFs were closed in 3 or more layers. A variety of flaps were used as needed. A suprapubic or foley catheter was left indwelling for 3?4 weeks and healing was assessed by cystourethrogram.

Results

Mean patient age was 49.2 (range 21?81). 13 (36%) were long?time smokers. 8 patients had a history of urethral diverticulum and 3 had previously treated pelvic malignancies. All patients had prior pelvic surgery. The most common etiology was an incontinence procedure in 13 patients (36%) with mesh erosion in 6 of these. Other causes were urethral diverticulum repair in 7 (19.4%), forceps delivery in 5 (14%), self?intermittent catheterization in 3 (8%), cystectomy and neobladder in 2 (6%), and other vaginal procedures in 6 (17%). Incontinence was the primary complaint in 33 women and the diagnosis was made on cystoscopy in 34. Thirty?four (94%) were closed via transvaginal approach including 15 with simultaneous rectus fascia pubovaginal slings harvested through an abdominal incision. Two were approached transabdominally, and 1 was closed with a combined abdominal and vaginal approach. Thirteen repairs were done with flaps including Martius in 11 and omentum in 2. Mean hospital stay was 3.9 days (range 0.5?10). The overall repair success rate was 34/36 (94%). Mean follow?up time was 41.2 months (range 0.8?207.33). Long?term LUTS included frequency in 11 patients (31%), urgency in 10 (28%), urgency incontinence in 9 (25%), and stress incontinence in 6 (17%). Foley catheter drainage replaced suprapubic drainage in the past 10 years but did not change outcomes. Two recurrences (1 neobladder and 1 post?ileocystoplasty) occurred immediately and underwent continent diversion.

Conclusions

UVFs usually result from a surgical complication. Smoking may be a risk factor. Management techniques that optimized outcomes included multi?layer closure usually with flaps and/or rectus fascial sling, extended catheter drainage, and tailoring the repair to the problem. _x000D_

Funding

none