Clinical Management Of Female Urinary Fistula

Objective:To explore the etiological factors and characteristics of female urinary fistula,summarize the factors influencing surgical results and to offer the preventive measures.Methods:To analyse the of female urinary fistula patients'clinical data,including the cause of fistula,fistula location,treatment methods and outcomes,and the following-up results,who have been treated in the department of urology,the 2nd Hospital of Kunming Medical University.There are 184 cases,of which 119 cases of vesicovaginal fistula,41 cases of ureterovaginal fistula(left 24,right 17),24 cases of ureterovaginal fistula.The patients ranged from 6 to 73 years old,with a median age of 44 years,and the course of vaginal urine leakage was 1 day to 30 years,with a median course of 7 months.Among 184 cases,101 cases were occurred by hysterectomy,50 cases were obstetric fistula,14 cases were caused by non-gynecological and obstetric surgery,6 cases were radioactive fistula,13 cases were non-iatrogenic fistula.All patients were confirmed by methylene blue test,cystoscopy,IVU?CT?MRI and CTU,and surgical procedures was performed after diagnosis.119 cases of vesicovaginal fistula,67 cases were repaired by open surgery,34 cases by transvaginal and 18 cases by laparoscopy.Among 41 cases of ureterovaginal fistula,30 cases underwent open surgery,11 cases underwent laparoscopic surgery,of which 39 underwent ureterovesical replantation and 2 underwent ureteroplasty with bladder wall muscle flaps.24 cases of urethrovaginal fistula,18 cases were repaired transvaginally;and 6 cases with urethral defect,of which 5 cases had been treated transabdominally and transvaginally to repair the fistula and reconstruct the urethra using the pedicled bladder muscle,and 1 case had been dong transvaginally to repair the fistula and reconstruct the urethra using the pedicled viginal anterior wall.Among 184 cases,32 patients were repaired less than 3 months(early stage)since the fistula,and 152 patients were repaired over 3 months(delayed)since the fistula.154 cases were primary operation and 30 cases were two or more operations.Postoperative indwelling catheter for 7 days to 4 weeks in all patients,ureteral stents were retained in 58 patients for 4 to 8 weeks,and urine drainage was maintained smoothly.The therapeutic effects of different methods for the same fistula were compared.All cases were followed up for 3 months to 6 months,included recurrence of urinary leakage and changes in quality of life.Results:In 184 cases,151 cases were due to gynecological and obstetric surgery injury.One hundred and sixty-six(90.2%)were repaired successful.The successful rates of open surgery,transvaginal and laparoscopic repair of vesicovaginal fistula were 88.1%,88.2%,and 88.9%.The successful rates of open surgery and laparoscopic of ureterovaginal fistula were 96.7%and 100%.The successful rates of simple transvaginal and utilization pedicled valves surgery of urethrovaginal fistula were 83.3%and 100%.The early and delayed operation have no significant difference in surgical success rates(84.4%vs.91.4%,P=0.370).The first and second or more operations have significant differences in success rates(92.9%vs.76.7%,P=0.017).During the following-up,no urinary leakage occurred in the successful surgery group,there was significant difference in quality of life between preoperative and postoperative(P<0.001).Conclusions:Gynecological and obstetric surgery injury is the main reason of female urinary fistula at present.It is very important to keep vigilance,familiarity with pelvic anatomy,careful preoperative preparation and careful surgical planning.Once urinary fistula occurs,the majority of patients need surgical procedures.The success rate of different surgical approaches for the same type of fistula is similar,surgeon's experience and patient's individual condition are the direct influence factor;if the condition is satisfied,early operation should be performed;the effect of the first operation is better than the reoperation;the life quality of patients had significantly improvement after surgery.