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01-09-2021 | Stress Incontinence | Original Article

Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up

Authors: Sridhar Panaiyadiyan, Bharti Uppal Nayyar, Rishi Nayyar, Neeraj Kumar, Amlesh Seth, Rajeev Kumar, Prabhjot Singh, Brusabhanu Nayak, Manoj Kumar

Published in: International Urogynecology Journal | Issue 9/2021

Abstract

Introduction and hypothesis

While the anatomical closure rates of vesicovaginal fistula (VVF) following transabdominal (TA) and transvaginal (TV) repairs seem comparable, studies comparing urinary and sexual outcomes following successful repair are lacking. We aimed to report patient-reported outcomes on sexual and urinary functions after long-term follow-up with successful repair.

Methods

We retrospectively reviewed 81 women who had successful VVF repair at our institute. Pre-, intra- and post-operative details were retrieved from electronic data software. Patient-reported sexual and urinary function outcomes were assessed using the Female Sexual Function Index (FSFI) questionnaire and International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), respectively, at last follow-up. We also compared such outcomes among TA and TV repairs.

Results

Of 81 women, 28 (34.6%) had TA and 53 (65.4%) had TV repairs. Mean age was 37.5 years and mean fistula diameter was 12.9 mm. The most common aetiology was hysterectomy. Thirty-three patients (40.7%) had previous failed repairs. At a mean follow-up of 29.8 months, 24 (34.3%) women had sexual dysfunction and 15 (18.5%) women experienced urinary dysfunction. The TA and TV groups had comparable mean FSFI scores (28.7 ± 6.1 vs. 30.9 ± 5.2, p = 0.13) and ICIQ-SF scores (0.7 ± 1.7 vs. 0.5 ± 1.4, p = 0.59). In multivariate analysis, fistula size and site were significant predictors of urinary dysfunction whereas multiparity was the most significant predictor of sexual dysfunction.

Conclusions

Sexual and urinary dysfunction is found in a considerable number of women after VVF repair. However, our data suggest comparable long-term sexual and continence outcomes between TA and TV repairs.

Härkki-Sirén P. Urinary tract injuries after hysterectomy. Obstet Gynecol. 1998;92:113–8. https://doi.org/10.1016/S0029-7844(98)00146-X.CrossRefPubMed

Ghoniem GM, Khater UM. Vesico-Vaginal Fistula. In: Davila GW, Ghoniem GM, Wexner SD, editors. Pelvic floor dysfunction. London: Springer-Verlag; 2006. p. 321–4.CrossRef

Ghoniem GM, Warda HA. The management of genitourinary fistula in the third millennium. Arab J Urol. 2014;12:97–105. https://doi.org/10.1016/j.aju.2013.11.006.CrossRefPubMedPubMedCentral

Warner R, Beardmore-Gray A, Pakzad M, et al. The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae. Int Urogynecol J. 2020;31:1363–9. https://doi.org/10.1007/s00192-019-04015-7.CrossRefPubMed

Mohr S, Brandner S, Mueller MD, et al. Sexual function after vaginal and abdominal fistula repair. Am J Obstet Gynecol. 2014;211:74.e1–6. https://doi.org/10.1016/j.ajog.2014.02.011.CrossRef

Pope R, Ganesh P, Chalamanda C, et al. Sexual function before and after vesicovaginal fistula repair. J Sex Med. 2018;15:1125–32. https://doi.org/10.1016/j.jsxm.2018.06.006.CrossRefPubMed

Ekwedigwe KC, Isikhuemen ME, Sunday-Adeoye I, et al. Bladder spasm following urogenital fistula repair. Int J Gynaecol Obstet. 2017;138:299–303. https://doi.org/10.1002/ijgo.12226.CrossRefPubMed

Shaw C. A systematic review of the literature on the prevalence of sexual impairment in women with urinary incontinence and the prevalence of urinary leakage during sexual activity. Eur Urol. 2002;42:432–40. https://doi.org/10.1016/s0302-2838(02)00401-3.CrossRefPubMed

O’Conor VJ, Kenneth Sokol J, Bulkley GJ, Nanninga JB. Suprapubic Closure of Vesicovaginal Fistula. J Urol. 1973;109:51–4. https://doi.org/10.1016/S0022-5347(17)60345-8.CrossRefPubMed

10.

Karmakar D, Mostafa A, Abdel-Fattah M. A new validated score for detecting patient-reported success on postoperative ICIQ-SF: a novel two-stage analysis from two large RCT cohorts. Int Urogynecol J. 2017;28:95–100. https://doi.org/10.1007/s00192-016-3070-0.CrossRefPubMed

11.

Rosen CBJ, Heiman S, Leiblum C, Meston R, Shabsigh D, Ferguson R, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Null. 2000;26:191–208. https://doi.org/10.1080/009262300278597.CrossRef

12.

Stress urinary incontinence. In: ICS. https://www.ics.org/committees/standardisation/terminologydiscussions/sui. Accessed 15 Jul 2020.

13.

ICS Glossary. In: ICS. https://www.ics.org/glossary/symptom/urgencyurinaryincontinenceuui. Accessed 15 Jul 2020.

14.

Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31:1–20. https://doi.org/10.1080/00926230590475206.CrossRefPubMed

15.

Alio AP, Merrell L, Roxburgh K, et al. The psychosocial impact of vesico-vaginal fistula in Niger. Arch Gynecol Obstet. 2011;284:371–8. https://doi.org/10.1007/s00404-010-1652-5.CrossRefPubMed

16.

Grewal M, Pakzad MH, Hamid R, et al. The medium- to long-term functional outcomes of women who have had successful anatomical closure of vesicovaginal fistulae. Urol Ann. 2019;11:247–51. https://doi.org/10.4103/UA.UA_56_18.CrossRefPubMedPubMedCentral

17.

Lee D, Zimmern P. Vaginal approach to Vesicovaginal fistula. Urol Clin North Am. 2019;46:123–33. https://doi.org/10.1016/j.ucl.2018.08.010.CrossRefPubMed

18.

Anzaku SA, Lengmang SJ, Mikah S, et al. Sexual activity among Nigerian women following successful obstetric fistula repair. Int J Gynaecol Obstet. 2017;137:67–71. https://doi.org/10.1002/ijgo.12083.CrossRefPubMed

19.

Hillary CJ, Osman NI, Hilton P, Chapple CR. The aetiology, treatment, and outcome of urogenital fistulae managed in well- and low-resourced countries: a systematic review. Eur Urol. 2016;70:478–92. https://doi.org/10.1016/j.eururo.2016.02.015.CrossRefPubMed

20.

Roy P, Gupta B, Tripathi A, et al. Sexual functioning in females with depression in remission receiving escitalopram. Indian J Med Res. 2019;150(6):606–11.CrossRef

21.

Mishra VV, Nanda S, Vyas B, et al. Prevalence of female sexual dysfunction among Indian fertile females. J Midlife Health. 2016;7(4):154–8.PubMedPubMedCentral

Title: Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up
Authors: Sridhar Panaiyadiyan
Bharti Uppal Nayyar
Rishi Nayyar
Neeraj Kumar
Amlesh Seth
Rajeev Kumar
Prabhjot Singh
Brusabhanu Nayak
Manoj Kumar
Publication date: 01-09-2021
Publisher: Springer International Publishing
Keyword: Stress Incontinence
Published in: International Urogynecology Journal / Issue 9/2021
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04648-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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