Neu Sarah, Locke Jennifer, Goldenberg Mitchell, Herschorn Sender
Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Division of Urology, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2021 May;15(5):E276-E280. doi: 10.5489/cuaj.6786.
We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement.
All patients diagnosed with UVF at our center from 1988-2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair.
A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35-62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4-72).
UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.
我们试图回顾尿道阴道瘘（UVF）修复的结果，无论是否同时放置筋膜吊带。
本研究纳入了1988年至2017年在我们中心诊断为UVF的所有患者。从前瞻性保存的瘘管数据库中回顾患者病历，并描述患者特征和手术结果。应用描述性统计比较UVF修复时有无筋膜吊带放置患者的并发症发生率。
共确定41例UVF患者，均接受了手术修复。诊断时的中位年龄为49岁（四分位间距[IQR]35 - 62岁）。所有患者均接受过盆腔手术。UVF的病因继发于压力性尿失禁（SUI）手术的有17例患者（41%），继发于尿道憩室修复的有7例患者（17%）。最常见的症状是19例患者（46%）出现持续性尿失禁。19例患者在手术时放置了筋膜吊带（46%），并发症发生率无显著差异（26%对23%，p = 0.79）。2例患者出现Clavien - Dindo I级并发症（5%），1例出现III级并发症（2%）。4例患者有长期并发症（10%），包括尿潴留、慢性疼痛和尿道狭窄。2例患者出现UVF复发（5%）。术后中位随访时间为21个月（IQR 4 - 72）。
手术后出现持续性尿失禁的患者应怀疑有UVF。大多数UVF手术修复是成功的，并且可以同时放置筋膜吊带。
