Mp48-20 Long-Term Patient-Reported Outcomes After Female Urogenital Fistula Repair: 15 Years at a Reconstructive Center

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) I (MP48)1 May 2024MP48-20 LONG-TERM PATIENT-REPORTED OUTCOMES AFTER FEMALE UROGENITAL FISTULA REPAIR: 15 YEARS AT A RECONSTRUCTIVE CENTER Jakob Klemm, Daniel Stelzl, Robert J. Schulz, Shahrokh F. Shariat, Margit Fisch, Roland Dahlem, and Malte W. Vetterlein Jakob KlemmJakob Klemm , Daniel StelzlDaniel Stelzl , Robert J. SchulzRobert J. Schulz , Shahrokh F. ShariatShahrokh F. Shariat , Margit FischMargit Fisch , Roland DahlemRoland Dahlem , and Malte W. VetterleinMalte W. Vetterlein View All Author Informationhttps://doi.org/10.1097/01.JU.0001009512.15743.d7.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urogenital fistulas (UGFs) in Western countries primarily stem from iatrogenic procedures and significantly affect quality of life. However, a paucity of long-term and patient-reported outcome measures (PROMs) exists for UGF repair. This study aims to explore both long-term surgical and patient-reported outcomes following UGF procedures. METHODS: 50 women underwent UGF repair at our center 2010-2023. UGFs were classified as simple or complex by the WHO classification, patients were stratified by surgical approach (transvaginal vs. transabdominal). Etiological, fistula, and surgical characteristics were reported by descriptives and compared between the groups. Cross-sectional follow-up was performed by phone and electronically via a web-based survey. We assessed objective fistula closure rate and reinterventions for stress urinary incontinence (SUI) and subjective outcomes using validated questionnaires (ICIQ-FLUTS, ICIQ-FLUTSsex, ICIQ-Satisfaction). Comparisons between the treatment groups were performed using χ2, Mann-Whitney U, and Fisher's exact tests, as appropriate. RESULTS: Of 50 patients, 17 (34%) had urethrovaginal fistulas (UVFs) and underwent transvaginal surgery, while 33 (66%) had vesicovaginal fistulas (VVFs) and were treated with transabdominal surgery. Overall, 23 (46%) were classified as complex, and 18 (36%) were redo cases. In VVF cases, peritoneal flaps were used in 76%, while 59% of UVF repairs employed Martius flaps for tissue interposition. Median operative time was 130 min (IQR 88-148). Median follow-up in censored patients was 44 mo (IQR 16-90). Fistula closure rate was 94% and 100% after 3 redo UGF repairs. All 7 (14%) reinterventions for SUI (6 autologous fascial sling, 1 midurethral sling) were performed in women who had undergone transvaginal UGF repair. Median time to assessing PROMs was 50 mo (IQR 16–90) and complete PROM questionnaires were available in 35 patients (70%). Median (IQR) ICIQ-FLUTS score was 5 (3-7), 1 (0-2), 4.5 (1-9), and 3 (1-5) for filling (ref. range 0-16), voiding (ref. range 0-12), incontinence symptoms (ref. range 0-20), and ICIQ-FLUTSsex (ref. range 0-14), respectively. Median (IQR) ICIQ-S outcome (ref. range 0-24) and satisfaction scores (ref. range 0-10) were 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. The surgical approach did not significantly affect the outcomes (all p>0.2). CONCLUSIONS: At a tertiary referral center, UGF repair shows excellent outcomes and patient satisfaction. However, patients with UVF face a higher risk of SUI, likely due to the initial trauma's site causing the fistula. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e781 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jakob Klemm More articles by this author Daniel Stelzl More articles by this author Robert J. Schulz More articles by this author Shahrokh F. Shariat More articles by this author Margit Fisch More articles by this author Roland Dahlem More articles by this author Malte W. Vetterlein More articles by this author Expand All Advertisement PDF downloadLoading ...