Chaker Kays, Rahoui Moez, Gharbia Nader, Chakroun Ali, Mosbahi Boutheina, Zribi Samar, Ouanes Yassine, Bibi Mokhtar, Ben Chedly Wassim, Nouira Yassine
Urology Department, La Rabta Hospital, University of Tunis El Manar, 1006 Tunis, Tunisia.
Urology Department, La Rabta Hospital, University of Tunis El Manar, 1006 Tunis, Tunisia.
Fr J Urol. 2025 Jun;35(5):102869. doi: 10.1016/j.fjurol.2025.102869. Epub 2025 Feb 18.
Vesicovaginal fistula (VVF) is one of the most important diseases related to quality of life in women's diseases and postoperative complications. We aimed to identify preoperative predictive factors of fistula repair failure and to develop a predictive model for this disorder.
The data from patients who underwent VVF repair from January 2010 and December 2020 were recorded and analyzed. The therapeutic results were assessed after a follow-up of at least six months. A successful VVF repair was defined as: closed VVF as noted on visual inspection of both the bladder and the vagina, no subjective complaints of vaginal leakage, no evidence of leakage during Valsalva and cough from the vaginal closure area using a half-speculum. Variables associated with fistula repair failure in the univariate analysis were included in a multivariate model using binary logistic regression to determine the independent factors of this disorder. All statistical analyses were performed using SPSS, and significance was set at 0.05%.
Ninety-eight patients were identified. The median age of patients was 50 (interquartile range: 42-55) years. Failure of surgical treatment of VVF has been reported in 32 (32.7%) cases. Patients with failed surgical treatment had the higher size of fistula (P=0.03), supratrigonal fistula (P=0.02) and vaginal fibrosis (P=0.001). On multivariate analysis, vaginal fibrosis (adjusted OR=4.2; 95% CI=1.398-12.739; P=0.01) and supratrigonal VVF (Adjusted OR=3.3; 95% CI=1.18-9.26; P=0.02) were independent factors of fistula repair failure. These two predictors were used to calculate the probability of combined success given by the following formula: e/(1+e), where b=-0.195+1.436×(for the vaginal fibrosis)+1.196×(for a supratrigonal VVF). The model had a sensitivity of 50% and a specificity of 86.36%.
Treatment failure was, in our series, correlated with the quality of the vaginal tissue and the seat of the fistula. This study demonstrated that vaginal fibrosis and supratrigonal fistula location are independent risk factors for failure of surgical treatment of VVF.
膀胱阴道瘘（VVF）是女性疾病和术后并发症中与生活质量相关的最重要疾病之一。我们旨在确定瘘管修复失败的术前预测因素，并建立该疾病的预测模型。
记录并分析2010年1月至2020年12月期间接受VVF修复的患者数据。至少随访六个月后评估治疗结果。成功的VVF修复定义为：膀胱和阴道视诊时VVF闭合，无阴道漏液的主观主诉，使用半窥器检查时在瓦尔萨尔瓦动作和咳嗽时阴道闭合区域无漏液迹象。单因素分析中与瘘管修复失败相关的变量纳入多变量模型，采用二元逻辑回归确定该疾病的独立因素。所有统计分析均使用SPSS进行，显著性设定为0.05%。
共纳入98例患者。患者的中位年龄为50岁（四分位间距：42 - 55岁）。32例（32.7%）报告手术治疗失败。手术治疗失败的患者瘘管尺寸更大（P = 0.03）、膀胱三角上瘘（P = 0.02）和阴道纤维化（P = 0.001）。多因素分析显示，阴道纤维化（调整后OR = 4.2；95% CI = 1.398 - 12.739；P = 0.01）和膀胱三角上VVF（调整后OR = 3.3；95% CI = 1.18 - 9.26；P = 0.02）是瘘管修复失败的独立因素。这两个预测因素用于通过以下公式计算联合成功的概率：e /(1 + e)，其中b = -0.195 + 1.436×（用于阴道纤维化）+ 1.196×（用于膀胱三角上VVF）。该模型的敏感性为50%，特异性为86.36%。
在我们的系列研究中，治疗失败与阴道组织质量和瘘管位置相关。本研究表明，阴道纤维化和膀胱三角上瘘管位置是VVF手术治疗失败的独立危险因素。
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