title: Long-term functional outcomes following nonradiated vesicovaginal repair.
abstract: OBJECTIVE
  We investigated the long-term impact on bladder and sexual symptoms in women with prior vesicovaginal fistula repair, particularly those previously treated before referral.
  
  
  METHODS
  After receiving institutional review board approval we reviewed the charts of women who underwent nonradiated vesicovaginal fistula repair for demographics, surgical approach (vaginal or abdominal) and functional outcomes with a minimum 6-month followup. Patients lost to followup were reached by a structured phone interview and/or mailed validated lower urinary tract questionnaires, including the UDI-6 (Urogenital Distress Inventory-6), IIQ-7 (Incontinence Impact Questionnaire-7) and FSFI (Female Sexual Function Index). Three surgical groups were compared, including naïve-no prior repair, recurrent-1 prior repair and other-more than 2 repairs with the hypothesis of worse outcomes with more repairs.
  
  
  RESULTS
  From 1996 to 2011 vesicovaginal fistula repair was performed in 66 patients, including in 42 as primary treatment (vaginal vs abdominal approach in 31 vs 11), in 14 as secondary treatment, and in 10 who underwent more than 2 repairs. Mean patient age was 45 years (range 24 to 87), mean body mass index was 29 kg/m(2) (range 19 to 43) and mean followup was 55 months (range 6 to 198). The overall repair success rate was 97%. There was no difference in functional outcomes in questionnaire responders among the 3 groups for lower urinary tract symptoms (62% on UDI-6/IIQ-7). However, for FSFI (33% of patients) there was female sexual dysfunction in patients who underwent transabdominal repair and in women with 2 repairs.
  
  
  CONCLUSIONS
  Long-term followup of patients with vesicovaginal fistula repair indicated no differences in lower urinary tract outcomes at a mean 7-year followup between primary and recurrent repairs. There was a difference in sexual function, although it was not statistically significant. Sexual activity among responders was low.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Dominic
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Dillon
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Lemack
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Philippe.zimmern@utsouthwestern.edu.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000150:complications / Q000601:surgery*; D055815:Young Adult
keywords: FSD; LUT; Q; QoL; VAS; VCUG; VVF; female sexual dysfunction; fistula; lower urinary tract; physiological; quality of life; question; questionnaires; sexual dysfunction; urinary bladder; vagina; vesicovaginal fistula; visual analog scale; voiding cystourethrogram