title: A tertiary experience of vesico-vaginal and urethro-vaginal fistula repair: factors predicting success.
abstract: OBJECTIVE
  To review the outcomes of all patients referred with vesico-vaginal (V VF) and urethro-vaginal (UVF) fistulae to a tertiary centre, and to investigate the patient, fistula and surgical factors relevant to success.
  
  
  METHODS
  We reviewed retrospectively the case-notes of 41 consecutive patients (32 with V VF; nine with UVF) treated between January 2000 and January 2006.
  
  
  RESULTS
  All patients were tertiary referrals, eight after failed local repairs. Four patients were unsalvageable and had a supravesical diversion. In all there were 47 repairs (23 transvaginal; 24 transabdominal) on 37 patients by two specialist surgeons. The fistula was closed in 92%; five V VF and one UVF required a second procedure, and one V VF a third procedure. One patient with a V VF awaits a second attempt at repair. In one V VF (one attempt) and one UVF (three attempts) the procedure failed and the patient had a diversion. A transvaginal approach cured all 11 patients with a V VF and eight of nine with a UVF, whilst an abdominal approach used for larger/complex fistulae was successful in 18 of 24 (75%) attempts (P = 0.13). The major determinants of success were fistula size (>3 cm; P = 0.02) and the availability of tissue for interposition. V VF repairs using Martius/omental interposition were mostly successful, whilst abdominal repairs in which omentum was unavailable tended to fail (37.5% cure; P = 0.002).
  
  
  CONCLUSIONS
  Despite varied aetiology, V VF/UVF were repaired successfully in 92% of patients. Complex (V VF) fistulae were challenging and a quarter of these required more than one attempt. Failure of repair was more likely in larger fistulae (>3 cm) requiring an abdominal approach, if omental interposition was not possible. Good-quality tissue interposition for complex fistula is essential for a successful outcome.
authors.affiliation: Institute of Urology, University College London Hospital, London, UK. jeremy.ockrim@uclh.nhs.uk
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Ockrim
authors.forename: Tamsin J
authors.initials: TJ
authors.lastname: Greenwell
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Foley
authors.forename: Dan N
authors.initials: DN
authors.lastname: Wood
authors.forename: P Julian R
authors.initials: PJ
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery; D055815:Young Adult