Clinical Characteristics of Urinary-Vaginal Fistulas After Various types of hysterectomy

Han, Chang Hee; Lee, Yong Seok; Kang, Sung Hak; Lee, Jin Woo; Park, Tae Chul

Abstract

OBJECTIVE
We reviewed the frequency and characteristics of urinary-vaginal fistulas after various types of total hysterectomy.
METHODS
We analyzed retrospectively 12 women with urinary-vaginal fistulas (10 vesicovaginal, 2 ureterovaginal) after total hysterectomy from January 1994 to December 2003. Hysterectomies included total abdominal hysterectomies (TAH), vaginal hysterectomies (TVH), laparoscopic hysterectomies (TLH), radical hysterectomies (RH), and cesarean hysterectomies (CH). The parameters that were analyzed included age, incidence with respect to the type of hysterectomy, past history, time of onset of the urine leakage and interval between leakage, corrective surgery, location of fistula, type of repair, and results.
RESULTS
During the study period, 3,561 hysterectomies were carried out. TAH accounted for 68.9% of procedures, TVH for 14.4%, TLH for 11.6%, RH for 3.3%, and CH for 1.7%. The incidence of vesicovaginal and ureterovaginal fistula was 0.24% and 0% for TAH, 0.48% and 0.48% for TLH, 0.84% and 0% for RH, and 1.67% and 0% for CH, respectively. No fistula was developed after TVH. Urine leakages were developed 5 to 28 days (mean, 14.5 days) after hysterectomies and the intervals between urine leakage and corrective surgery were 7 to 28 days (mean, 16.3 days). The intervals between hysterectomy and corrective surgery were 21 to 54 days (mean, 34.6 days). Corrective surgeries (10 suprapubic transvesical repairs for vesicovaginal fistulas and 2 ureteroneocystostomies for ureterovaginal fistulas) were performed soon after establishment of diagnosis. There was no significant complication and recurrence of fistula after corrective surgery.
CONCLUSION
The overall incidence of urinary-vaginal fistula was 0.3%, respectively. The fistulas were more frequently developed after CH than other types of hysterectomy. And the fistulas may be repaired definitively soon after diagnosis of the problem with good results.