Tikhonova L V, Kasyan G R, Stroganov A B, Mukhtarov S T, Sheripbaev R B, Dyakov V V, Pushkar D Yu
Department of Urology of A. I. Evdokimov Moscow State University of Medicine and Dentistry.
AO European Medical Center, urologic clinic, Moscow, Russia.
Urologiia. 2021 Mar(1):13-20.
Studies on non-obstetric urogenital fistula provide limited information on predictive factors. The aim of our study was to specify and to analyze the predictors for long-term anatomical and functional results in women with non-obstetric urogenital fistula.
A cross-section study of surgical repair for non-obstetric urogenital fistula repairs was carried out. From 2012 to 2018, a total of 446 patients with urogenital fistulas were treated in two tertiary centers. Patients with vesicovaginal and urethrovaginal fistulas with at least 12 months of follow-up were identified and contacted by phone and/or examined in the clinic. Anatomical outcome was assessed by resolution of symptoms and/or results of clinical examination. Urinary distress inventory (UDI-6) was used for the measurement of functional outcomes. The nomogram is based on a multiple regression equation, the solution of which is performed using a computer. The nomogram is presented as a set of scales, each of which corresponds to a certain variable. The baseline parameter is assigned certain points, depending on its value, then the sum of all parameters is calculated. As a result, it is possible to determine the risk using a couple or three scales.
Overall, 169 patients were studied (mean age of 49.2, mean follow-up of 34 months). The most common cause of fistulas included hysterectomy (69.4%), followed by pelvic radiotherapy (18.9%). Only 64% of cases were primary fistula. Closure rate was 90.7% (98/108). Anatomical success depended on the surgical approach. For transvesical procedure, success rate was 89.4% (42/47), compared to 84% (89/106) and 87.5% (14/16), respectively for transvaginal and transabdominal success rate. According to Clavien-Dindo, complications were grade 1 (11.8%) and grade 2 (4.7%). As UDI-6 showed, the most common symptoms were frequency (62%), urgency (50%), incontinence (73%), pain (55%) and voiding symptoms (27%). Fistula size > 3.0 cm, pelvic radiation, and previous vaginal surgeries were associated with a higher risk of failure or more severe lower urinary tract symptoms. A high number of re-do cases and complex fistulas could be a limitation of this study. Factors for successful non-obstetric urogenital fistula closure were fistula size less than 3.0 cm, absence of pelvic radiation, and previous vaginal surgeries.
According to our results, only fistula size > 3 cm, previous vaginal procedures and pelvis irradiation were unfavorable predictors for anatomic success of fistula repair. In addition, our results allow to determine the predictors for successful repair and risk of recurrence lower urinary tract symptoms postoperatively.
关于非产科泌尿生殖道瘘的研究提供的预测因素信息有限。我们研究的目的是明确并分析非产科泌尿生殖道瘘女性患者长期解剖和功能结果的预测因素。
对非产科泌尿生殖道瘘修补术进行了一项横断面研究。2012年至2018年，两个三级中心共治疗了446例泌尿生殖道瘘患者。确定膀胱阴道瘘和尿道阴道瘘且至少随访12个月的患者，并通过电话联系和/或在诊所进行检查。通过症状缓解和/或临床检查结果评估解剖学结果。使用泌尿困扰量表（UDI - 6）测量功能结果。列线图基于多元回归方程，通过计算机求解。列线图以一组量表呈现，每个量表对应一个特定变量。根据基线参数的值赋予其一定分数，然后计算所有参数的总和。结果，可以使用两个或三个量表确定风险。
总体上，研究了169例患者（平均年龄49.2岁，平均随访34个月）。瘘的最常见原因包括子宫切除术（69.4%），其次是盆腔放疗（18.9%）。仅64%的病例为原发性瘘。闭合率为90.7%（98/108）。解剖学成功取决于手术方式。经膀胱手术的成功率为89.4%（42/47），经阴道和经腹手术的成功率分别为84%（89/106）和87.5%（14/16）。根据Clavien - Dindo分类，并发症为1级（11.8%）和2级（4.7%）。如UDI - 6所示，最常见的症状是尿频（62%）、尿急（50%）、尿失禁（73%）、疼痛（55%）和排尿症状（27%）。瘘口大小>3.0 cm、盆腔放疗和既往阴道手术与更高的失败风险或更严重的下尿路症状相关。大量再次手术病例和复杂瘘可能是本研究的一个局限。非产科泌尿生殖道瘘成功闭合的因素是瘘口大小小于3.0 cm、无盆腔放疗和既往无阴道手术。
根据我们的结果，仅瘘口大小>3 cm、既往阴道手术和盆腔放疗是瘘修补术解剖学成功的不利预测因素。此外，我们的结果有助于确定成功修复的预测因素以及术后下尿路症状复发的风险。
