Risk factors that predict failure after vaginal repair of obstetric vesicovaginal fistulae.

Abstract

To identify anatomic characteristics and method of bladder closure that predict failure after repair of obstetric vesicovaginal fistulae. A retrospective analysis of 1045 patients that underwent vaginal repair of vesicovaginal fistulae from January 2006 to December 2007 at the Addis Ababa Hamlin Fistula Hospital. The fistulae were midvaginal (26%), adjacent to ureteral orifice (22%), circumferential (6%), had urethral compromise (10%), or had a combination of different locations (17%). Most had fair or good residual bladder size (83%) and minimal or moderate vaginal scarring (85%). Closure was in 1 layer in 48% and 2 layers in 52% with 89% cure, 11% failure, and 17% urethral incontinence. Failures were significantly associated with complete or partial urethral destruction, severe vaginal scarring, small bladders, and circumferential involvement. The 1-layer fistula closure was associated with failure but not after excluding small bladders. Risk factors for failure include small bladder size, urethral destruction, circumferential involvement, and severe vaginal scarring.