OBJECTIVE: To identify anatomic characteristics and method of bladder closure that predict failure after repair of obstetric vesicovaginal fistulae. STUDY DESIGN: A retrospective analysis of 1045 patients that underwent vaginal repair of vesicovaginal fistulae from January 2006 to December 2007 at the Addis Ababa Hamlin Fistula Hospital. RESULTS: The fistulae were midvaginal (26%), adjacent to ureteral orifice (22%), circumferential (6%), had urethral compromise (10%), or had a combination of different locations (17%). Most had fair or good residual bladder size (83%) and minimal or moderate vaginal scarring (85%). Closure was in 1 layer in 48% and 2 layers in 52% with 89% cure, 11% failure, and 17% urethral incontinence. Failures were significantly associated with complete or partial urethral destruction, severe vaginal scarring, small bladders, and circumferential involvement. The 1-layer fistula closure was associated with failure but not after excluding small bladders.

CONCLUSION: Risk factors for failure include small bladder size, urethral destruction, circumferential involvement, and severe vaginal scarring.

Am J Obstet Gynecol. 2009 Feb 5;

Authors: Nardos R, Browning A, Chen CC

PMID: 19200932 [PubMed - as supplied by publisher]