title: Bladder stones in vesicovaginal fistula: is concurrent repair an option? Experience with 87 patients.
abstract: OBJECTIVE
  The objective was to assess the outcomes of a one-stage approach to bladder stones in the setting of a vesicovaginal fistula, performing fistula repair concurrently with stone extraction.
  
  
  METHODS
  Retrospective review of urogenital fistula surgeries at Evangel VVF Center in Jos, Nigeria, between December 2003 and April 2014, identified 87 women with bladder stones accompanying their fistulas and 2,979 repaired without stones. Concurrent stone extraction and fistula repair were performed in 51 patients. Outcomes were compared with respect to fistula size, classification, and fibrosis.
  
  
  RESULTS
  Women presenting with bladder stones were older and had larger fistulas than those without stones (P < 0.001). Additionally, their fistulas were more often classifiable as large and less often as high (P = 0.02), and were more fibrotic (P = 0.003). Twenty-six (51 %) patients with concurrent repair successfully became dry. Comparing results by classification, concurrent repair of high fistulas with stones was very likely to be successful (OR 8.8, 95% CI 1.0-78.2), whereas low fistulas were not (OR 0.2, 95% CI 0.02-0.7). Outcomes were similar to those of patients without stones, except for low fistulas, which were 5 times more likely to fail (P = 0.04).
  
  
  CONCLUSIONS
  Concurrent closure of vesicovaginal fistula at the time of bladder stone extraction is possible and, in many respects, preferable to a staged approach, particularly among high or midvaginal fistulas.
authors.affiliation: Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria. snshephard@gmail.com.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Shephard
authors.affiliation: Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria.
authors.forename: Sunday J
authors.initials: SJ
authors.lastname: Lengmang
authors.affiliation: Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria.|NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Carolyn V
authors.initials: CV
authors.lastname: Kirschner
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001744:Urinary Bladder Calculi / Q000150:complications* / Q000601:surgery; D013520:Urologic Surgical Procedures; D014719:Vesicovaginal Fistula / Q000150:complications* / Q000601:surgery; D055815:Young Adult
keywords: Bladder stones; Concurrent repair; Fistula; Nigeria; Surgical outcomes; Vesicovaginal