title: Urovaginal fistula formation after gynaecological and obstetric surgical procedures: clinical experiences in a Scandinavian series.
abstract: OBJECTIVE
  The aim of this retrospective study was to review what kinds of surgical procedures are most frequently complicated by urovaginal fistulae, to find out how they were diagnosed and managed, and to study the outcome after surgical reconstruction.
  
  
  METHODS
  Nineteen women who underwent fistula repair at Sahlgrenska University Hospital between 2003 and 2009 were retrospectively studied by reviewing the medical records.
  
  
  RESULTS
  For 17 of the 19 patients hysterectomy was the causative procedure. Fourteen patients developed vesicovaginal and five developed ureterovaginal fistula. Urethrocystoscopy was sufficient for the diagnosis in nearly 50% of the patients and when combined with methylene blue instillation 90% of all fistulae were found. Several patients sought medical advice due to vaginal leakage following gynaecological surgery without the doctor suspecting a fistula, and for these patients the diagnosis was delayed. Eighteen patients were operated on with an abdominal approach and one with a vaginal approach, in all cases a minimum of 3 months after primary surgery. The reconstruction technique included the interposition of vascularized tissue. None of the patients reported leakage or relapse at follow-up after fistula repair.
  
  
  CONCLUSIONS
  Hysterectomy was the most common cause behind the formation of urovaginal fistulae. Misinterpretation of symptoms after gynaecological surgery was common even in cases where the symptoms were indicative of a urovaginal fistula. Delayed fistula repair after a minimum of 3 months, via the abdominal route and with the interposition of vascularized tissue, yielded an excellent final outcome.
authors.affiliation: Department of Urology, Sahlgrenska Academy at The University of Gothenburg, Sweden.
authors.forename: Umit
authors.initials: U
authors.lastname: Demirci
authors.forename: Magnus
authors.initials: M
authors.lastname: Fall
authors.forename: Sofia
authors.initials: S
authors.lastname: Göthe
authors.forename: Johan
authors.initials: J
authors.lastname: Stranne
authors.forename: Ralph
authors.initials: R
authors.lastname: Peeker
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D013513:Obstetric Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014719:Vesicovaginal Fistula / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult