title: Management of vesicovaginal fistulae: a multicenter analysis from the Fellows' Pelvic Research Network.
abstract: OBJECTIVE
  Vesicovaginal fistulae (VVF) are the most commonly acquired fistulae of the urinary tract, but we lack a standardized algorithm for their management. The purpose of this multicenter study was to describe practice patterns and treatment outcomes of VVF in the United States.
  
  
  METHODS
  This institutional review board-approved multicenter review included 12 academic centers. Cases were identified using International Classification of Diseases codes for VVF from July 2006 through June 2011. Data collected included demographics, VVF type (simple or complex), location and size, management, and postoperative outcomes. χ(2), Fisher exact, and Student t tests, and odds ratios were used to compare VVF management strategies and treatment outcomes.
  
  
  RESULTS
  Two hundred twenty-six subjects were included. The mean age was 50 (14) years; mean body mass index was 29 (8) kg/m(2). Most were postmenopausal (53.0%), nonsmokers (59.5%), and white (71.4%). Benign gynecologic surgery was the cause for most VVF (76.2%). Most of VVF identified were simple (77.0%). Sixty (26.5%) VVF were initially managed conservatively with catheter drainage, of which 11.7% (7/60) resolved. Of the 166 VVF initially managed surgically, 77.5% resolved. In all, 219 subjects underwent surgical treatment and 83.1% of these were cured.
  
  
  CONCLUSIONS
  Most of VVF in this series was managed initially with surgery, with a 77.5% success rate. Of those treated conservatively, only 11.7% resolved. Surgery should be considered as the preferred approach to treat primary VVF.
authors.affiliation: From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH; †Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System & Kaiser Permanente, San Diego, CA; ‡Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; §Naval Medical Center, Portsmouth, VA; ∥Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Ob/Gyn and Urology, Stanford University School of Medicine, Stanford, CA; ¶Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; #Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; **Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX; ††Division of Urogynecology, University of South Florida, Tampa, FL; ‡‡Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL; §§Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH; ∥∥Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; and ##Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Oakley
authors.forename: Heidi W
authors.initials: HW
authors.lastname: Brown
authors.forename: Joy A
authors.initials: JA
authors.lastname: Greer
authors.forename: Monica L
authors.initials: ML
authors.lastname: Richardson
authors.forename: Amos
authors.initials: A
authors.lastname: Adelowo
authors.forename: Ladin
authors.initials: L
authors.lastname: Yurteri-Kaplan
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Lindo
authors.forename: Kristie A
authors.initials: KA
authors.lastname: Greene
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Fok
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Book
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Saiz
authors.forename: Leon N
authors.initials: LN
authors.lastname: Plowright
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Harvie
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Pauls
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000628:therapy*