Oakley Susan H, Brown Heidi W, Greer Joy A, Richardson Monica L, Adelowo Amos, Yurteri-Kaplan Ladin, Lindo Fiona M, Greene Kristie A, Fok Cynthia S, Book Nicole M, Saiz Cristina M, Plowright Leon N, Harvie Heidi S, Pauls Rachel N
From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH; †Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System & Kaiser Permanente, San Diego, CA; ‡Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; §Naval Medical Center, Portsmouth, VA; ∥Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Ob/Gyn and Urology, Stanford University School of Medicine, Stanford, CA; ¶Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; #Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; **Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX; ††Division of Urogynecology, University of South Florida, Tampa, FL; ‡‡Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL; §§Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH; ∥∥Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; and ##Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL.
Female Pelvic Med Reconstr Surg. 2014 Jan-Feb;20(1):7-13. doi: 10.1097/SPV.0000000000000041.
Vesicovaginal fistulae (VVF) are the most commonly acquired fistulae of the urinary tract, but we lack a standardized algorithm for their management. The purpose of this multicenter study was to describe practice patterns and treatment outcomes of VVF in the United States.
This institutional review board-approved multicenter review included 12 academic centers. Cases were identified using International Classification of Diseases codes for VVF from July 2006 through June 2011. Data collected included demographics, VVF type (simple or complex), location and size, management, and postoperative outcomes. χ(2), Fisher exact, and Student t tests, and odds ratios were used to compare VVF management strategies and treatment outcomes.
Two hundred twenty-six subjects were included. The mean age was 50 (14) years; mean body mass index was 29 (8) kg/m(2). Most were postmenopausal (53.0%), nonsmokers (59.5%), and white (71.4%). Benign gynecologic surgery was the cause for most VVF (76.2%). Most of VVF identified were simple (77.0%). Sixty (26.5%) VVF were initially managed conservatively with catheter drainage, of which 11.7% (7/60) resolved. Of the 166 VVF initially managed surgically, 77.5% resolved. In all, 219 subjects underwent surgical treatment and 83.1% of these were cured.
Most of VVF in this series was managed initially with surgery, with a 77.5% success rate. Of those treated conservatively, only 11.7% resolved. Surgery should be considered as the preferred approach to treat primary VVF.
膀胱阴道瘘（VVF）是最常见的后天性尿路瘘，但我们缺乏针对其治疗的标准化方案。这项多中心研究的目的是描述美国VVF的治疗模式和治疗结果。
这项经机构审查委员会批准的多中心回顾性研究纳入了12个学术中心。通过使用2006年7月至2011年6月期间VVF的国际疾病分类编码来确定病例。收集的数据包括人口统计学资料、VVF类型（简单型或复杂型）、位置和大小、治疗方法以及术后结果。采用χ²检验、Fisher精确检验、Student t检验和比值比来比较VVF的治疗策略和治疗结果。
共纳入226名受试者。平均年龄为50（14）岁；平均体重指数为29（8）kg/m²。大多数为绝经后女性（53.0%）、非吸烟者（59.5%）和白人（71.4%）。大多数VVF是由良性妇科手术引起的（76.2%）。大多数确诊的VVF为简单型（77.0%）。60例（26.5%）VVF最初采用导管引流进行保守治疗，其中11.7%（7/60）瘘口愈合。在最初接受手术治疗的166例VVF中，77.5%瘘口愈合。总共有219名受试者接受了手术治疗，其中83.1%治愈。
本系列研究中的大多数VVF最初采用手术治疗，成功率为77.5%。在那些接受保守治疗的患者中，只有11.7%瘘口愈合。手术应被视为治疗原发性VVF的首选方法。
