University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room MG406, Toronto, ON, M4N 3M5, Canada.
ICES, Toronto, ON, Canada.
World J Urol. 2024 Mar 13;42(1):149. doi: 10.1007/s00345-024-04812-w.
Vesicovaginal fistulae (VVF) have a significant negative impact on quality of life, with failed surgical repair resulting in ongoing morbidity. Our aim was to characterize the rate of VVF repair and repair failures over time, and to identify predictors of repair failure.
We completed a population-based, retrospective cohort study of all women who underwent VVF repair in Ontario, Canada, aged 18 and older between 2005 and 2018. Risk factors for repair failure were identified using multivariable cox proportional hazard analysis; interrupted time series analysis was used to determine change in VVF repair rate over time.
814 patients underwent VVF repair. Of these, 117 required a second repair (14%). Mean age at surgery was 52 years (SD 15). Most patients had undergone prior gynecological surgery (68%), and 76% were due to iatrogenic injury. Most repairs were performed by urologists (60%). Predictors of VVF re-repair included iatrogenic injury etiology (HR 2.1, 95% CI 1.3-3.45, p = 0.009), and endoscopic repair (HR 6.1, 95% CI 3.1-11.1, p < 0.05,); protective factors included combined intra-abdominal/trans-vaginal repair (HR 0.51, 95% CI 0.3-0.8, p = 0.009), and surgeon years in practice (21 + years-HR 0.5, 95% CI 0.3-0.9, p = 0.005). Age adjusted annual rate of VVF repair (ranging from 0.8 to 1.58 per 100,000 women) and re-repair did not change over time.
VVF repair and re-repair rates remained constant between 2005 and 2018. Iatrogenic injury and endoscopic repair predicted repair failure; combined intra-abdominal/trans-vaginal repair, and surgeon years in practice were protective. This suggests surgeon experience may protect against VVF repair failure.
膀胱阴道瘘（VVF）对生活质量有重大负面影响，手术修复失败会导致持续发病。我们的目的是描述 VVF 修复的发生率和随时间推移的修复失败率，并确定修复失败的预测因素。
我们对 2005 年至 2018 年期间在加拿大安大略省接受 VVF 修复的所有年龄在 18 岁及以上的女性进行了一项基于人群的回顾性队列研究。使用多变量 Cox 比例风险分析确定修复失败的危险因素；使用中断时间序列分析确定 VVF 修复率随时间的变化。
814 名患者接受了 VVF 修复。其中 117 人需要进行第二次修复（14%）。手术时的平均年龄为 52 岁（标准差 15 岁）。大多数患者曾接受过妇科手术（68%），76%是医源性损伤所致。大多数修复手术由泌尿科医生进行（60%）。VVF 再修复的预测因素包括医源性损伤病因（HR 2.1，95%CI 1.3-3.45，p=0.009）和内镜修复（HR 6.1，95%CI 3.1-11.1，p<0.05）；保护因素包括联合腹腔/阴道内修复（HR 0.51，95%CI 0.3-0.8，p=0.009）和外科医生从业年限（21+年-HR 0.5，95%CI 0.3-0.9，p=0.005）。调整年龄后，VF 修复的年发生率（0.8 至 1.58 例/10 万妇女）和再修复率在不同时间没有变化。
2005 年至 2018 年，VF 修复和再修复率保持不变。医源性损伤和内镜修复预示着修复失败；联合腹腔/阴道内修复和外科医生从业年限是保护性因素。这表明外科医生的经验可能有助于预防 VVF 修复失败。
