title: Management of urinary fistulas due to midurethral sling surgery.
abstract: OBJECTIVE
  We report our experience with the diagnosis and treatment of women with urinary fistula after mid urethral sling surgery.
  
  
  METHODS
  We retrospectively reviewed the records of patients with urinary fistula secondary to mid urethral sling surgery. Electronic medical records and billing records were searched. We analyzed sling type, presenting symptoms and interval from initial sling surgery to 1) symptom appearance, 2) fistula diagnosis and 3) fistula repair. Symptomatic outcomes were assessed by PGI-I. Surgical outcomes were based on history and examination.
  
  
  RESULTS
  We identified 10 women with a mean age of 58 years (range 37 to 70). Mean interval from mid urethral sling surgery to symptom onset, diagnosis and fistula repair was 2, 16 and 18 months, respectively. Mean followup was 26 months (range 4 to 96). There were 1 ureterovaginal, 1 enterovesical, 6 vesicovaginal and 7 urethrovaginal fistulas. Patients presented with stress urinary incontinence (70%), unaware incontinence (50%), overactive bladder (40%), pelvic pain (30%) and voiding symptoms (20%). Nine women underwent fistula repair and 1 underwent continent urinary diversion. A Martius flap was used in 6 of 9 patients, an omental flap and a bladder wall flap were used in 2 each, urethral reconstruction and ureterocolovesicostomy were performed in 1 each and 7 received an autologous pubovaginal sling. Seven patients (78%) underwent successful fistula repair. A successful symptomatic outcome was achieved in 5 of 7 women with stress urinary incontinence, 3 of 5 with unaware incontinence, 3 of 4 with overactive bladder, 2 of 3 with pelvic pain and 2 of 2 with voiding symptoms.
  
  
  CONCLUSIONS
  With careful attention to surgical principles and technique, including removal of as much of the adjacent mesh as possible, a successful outcome can be achieved in most patients with a fistula secondary to mid urethral sling surgery.
authors.affiliation: Weill Cornell Medical College, New York, New York; Institute for Bladder and Prostate Research, New York, New York.
authors.forename: Jerry G
authors.initials: JG
authors.lastname: Blaivas
authors.affiliation: Institute for Bladder and Prostate Research, New York, New York. Electronic address: gabrielmekel@yahoo.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mekel
mesh_terms: D000328:Adult; D000368:Aged; D003558:Cystoscopy; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014550:Urinary Incontinence, Stress / Q000601:surgery; D014563:Urodynamics
keywords: fistula; postoperative complications; suburethral sling; surgical mesh; urethra