Abstract

Introduction: Urogenital fistulas are usually surgical complications resulting from gynaecobsterical procedures, being considered as public health care indexes related to professional attention. Among urogenital fistulas, vesicovaginal fistulas (VVF) are the most frequent ones. Its prevalence is unknown, but it is estimated at 0,29 per 1000 women on reproductive age, according to geographical region. In high income countries its cause is iatrogenic, mainly gynecological, especially after total abdominal hysterectomy. Nevertheless, in low income coun- tries VVF develop after obstetric procedures such as prolonged and neglected labours. VVFs increase morbidity and affect patients quality of life, meaning social isolation, depression and sexual dysfunction. Objective: To describe the experience of a tertiary health center with regard to VVF repair. To characterize the population with VVF and evaluate the quality of life of patients after repair. Methods: A retrospective cohort study was completed, including every patient with VVF who underwent surgery in our center between 2018 and 2022. Clinical files were compiled and compared and a complete analysis of absolute and relative frequencies was designed using STATA software. Every patient answered the Patient Global Impression (PGI) standardized questionnaire to review their quality of life improvement. Results: 15 patients underwent surgical management of VVF in our center between January 2018 and December 2022. Three patients needed re intervention, meaning 80% of success after the first fis- tulectomy. The population had a median age of 46 years old (34-56 years old), median of 2 births (0-4). 46,6% had comorbidities, 20% overweight, 13% hypertension and 13,3% hipotyroidism. 73% of VVF developed after total benign abdominal hysterectomy, 6% after a radical hysterectomy and 20% after cesarean delivery. None of them resulted from vaginal deliveries or laparoscopic procedures. The latency period of development of symptoms was 8 days on average (1-60). 80% of VVF were repaired through vaginal approach, the rest were abdominal. Median surgical time was 129 minutes (65-370). 20% relapsed and the average time for their reintervention was 5 months. The whole cohort has now their VVF solved. In the postoperative period 30% presented stress urinary incontinence and 26% urgency incontinence. 6% dys- pareunia and 12.3% chronic pelvic pain. In relation to the quality of life after fistulectomy according to PGI, 100% reported some degree of improvement, of which 80% reported feeling much better, reincorporat- ing into social groups and work environments, 12.3% reported feeling better and 6% only slight improvement. Conclusions: All VVFs were iatrogenic in our cohort. Vaginal approach was preferred than abdominal, although both were successful. All patients reported improvement in their quality of life after repair, considered optimal by 80%. This study shows the need to prevent the appearance of fistulas by means of actions to protect the urinary tract during gyneco-obstetric interventions.