Does the Goh classification predict the outcome of vesico-vaginal fistula repair in the developed world?
OBJECTIVE
The Goh Vesico-Vaginal Fistula (VVF) classification has prognostic value in VVF in the developing world (predominantly obstetric), with chances of successful closure decreasing from type 1 to type 4. We evaluated the prognostic value of the Goh classification for VVF of the developed world (predominantly iatrogenic).


METHODS
A retrospective review was performed of 63 consecutive patients with a mean age of 53 years (range 21-88) undergoing VVF repair under a single surgeon between 2006 and 2014. Demographic data, aetiology, operative data and final outcome (anatomical and functional) were recorded. Fistulae were classified according to Goh's system and outcomes correlated with this classification.


RESULTS
Successful closure at first repair was achieved in 90 % of type 1, 83 % of type 2, 100 % of type 3 and 100 % of type 4 fistulae. At second repair success was achieved in 100 % of all fistulae, irrespective of type. Continence post-anatomical closure was achieved in 100 % of type 1, 83 % of type 2, 83 % of type 3 and 75 % of type 4 fistulae. Fistula size and patient age were significant determinants of successful outcome.


CONCLUSIONS
Anatomical closure was obtained in 90 % of VVF of the developed world at first attempt, 100 % overall, and was not affected by the Goh classification. Continence post-anatomical closure of VVF was 94 % overall and deteriorated with increasing Goh classification type. The Goh classification has no prognostic value regarding anatomical closure in VVF of the developed world, but may be useful in determining the risk of post-anatomical closure urinary incontinence. Smaller fistula size and younger patient age are significant determinants of success.
University College London Hospitals, London, UK. alice.beardmore-gray@gmail.com.
Alice
A
Beardmore-Gray
University College London Hospitals, London, UK.
Mahreen
M
Pakzad
University College London Hospitals, London, UK.
Rizwan
R
Hamid
University College London Hospitals, London, UK.
Jeremy
J
Ockrim
University College London Hospitals, London, UK.
Tamsin
T
Greenwell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000145:classification* / Q000601:surgery*; D055815:Young Adult
Classification; Outcome; Repair; Surgery; Vesico-vaginal fistula