Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Urol. 2014 Jan;191(1):120-4. doi: 10.1016/j.juro.2013.07.004. Epub 2013 Jul 10.
We investigated the long-term impact on bladder and sexual symptoms in women with prior vesicovaginal fistula repair, particularly those previously treated before referral.
After receiving institutional review board approval we reviewed the charts of women who underwent nonradiated vesicovaginal fistula repair for demographics, surgical approach (vaginal or abdominal) and functional outcomes with a minimum 6-month followup. Patients lost to followup were reached by a structured phone interview and/or mailed validated lower urinary tract questionnaires, including the UDI-6 (Urogenital Distress Inventory-6), IIQ-7 (Incontinence Impact Questionnaire-7) and FSFI (Female Sexual Function Index). Three surgical groups were compared, including naïve-no prior repair, recurrent-1 prior repair and other-more than 2 repairs with the hypothesis of worse outcomes with more repairs.
From 1996 to 2011 vesicovaginal fistula repair was performed in 66 patients, including in 42 as primary treatment (vaginal vs abdominal approach in 31 vs 11), in 14 as secondary treatment, and in 10 who underwent more than 2 repairs. Mean patient age was 45 years (range 24 to 87), mean body mass index was 29 kg/m(2) (range 19 to 43) and mean followup was 55 months (range 6 to 198). The overall repair success rate was 97%. There was no difference in functional outcomes in questionnaire responders among the 3 groups for lower urinary tract symptoms (62% on UDI-6/IIQ-7). However, for FSFI (33% of patients) there was female sexual dysfunction in patients who underwent transabdominal repair and in women with 2 repairs.
Long-term followup of patients with vesicovaginal fistula repair indicated no differences in lower urinary tract outcomes at a mean 7-year followup between primary and recurrent repairs. There was a difference in sexual function, although it was not statistically significant. Sexual activity among responders was low.
我们研究了既往行膀胱阴道瘘修补术的女性患者的膀胱和性功能的长期影响，尤其是那些转诊前曾接受过治疗的患者。
我们在获得机构审查委员会批准后，对接受非放射性膀胱阴道瘘修补术的女性患者的病历进行了回顾，记录患者的人口统计学特征、手术入路（阴道或腹部）以及至少 6 个月随访时的功能结局。对于失访患者，我们通过结构化电话访谈和/或邮寄经过验证的下尿路问卷进行了联系，包括 UDI-6（尿失禁影响问卷-6）、IIQ-7（尿失禁对生活质量的影响问卷-7）和 FSFI（女性性功能指数）。我们比较了三组手术患者，包括初治组（既往无修补史）、复治组（1 次修补史）和其他组（2 次或以上修补史），假设手术次数越多，结局越差。
1996 年至 2011 年，我们共对 66 例患者施行膀胱阴道瘘修补术，其中 42 例为初治（阴道入路 31 例，腹部入路 11 例），14 例为复治，10 例为多次修补。患者的平均年龄为 45 岁（24 至 87 岁），平均体重指数为 29 kg/m2（19 至 43），平均随访时间为 55 个月（6 至 198 个月）。总的手术成功率为 97%。在问卷调查应答者中，三组患者的下尿路症状的问卷评分（UDI-6/IIQ-7 评分，62%）无差异。然而，在 FSFI 评分（33%的患者）中，行腹部手术和接受 2 次以上修补的患者出现了女性性功能障碍。
在平均 7 年的随访中，我们对膀胱阴道瘘修补术患者进行了长期随访，结果显示，初治与复治患者的下尿路结局在长期随访中无差异。在性功能方面存在差异，但无统计学意义。应答者的性生活活跃度较低。
