A retrospective nested case-control study was conducted. A total of 15 patients who underwent unsuccessful transvaginal
vesicovaginal fistula repair in the Department of Urology, Peking University First Hospital from January 2014 to December 2020 were enrolled as the case group. A total of 60 patients receiving transvaginal
vesicovaginal fistula repair by the same surgeon within the same time range, were selected as the control group. The age, body mass index (BMI), etiology of
vesicovaginal fistula, associated genitourinary malformation, frequency of repair, characteristics of
fistula,
surgical procedure, postoperative recovery and other factors were compared between the case group and the control group, and the influencing factors of failure were analyzed.
RESULTS: The BMI of the case group was (26.3±3.9) kg/m2, the diameter of
vaginal fistula was (1.5±0.8) cm, and the
operative time of transvaginal repair was (111.8±19.8) min. The proportion of the patients with genitourinary malformations was 4/15, the proportion of the patients with multiple vaginal repairs was 13/15, the proportion of the patients with concurrent ureteral
reimplantation was 6/15, and the proportion of the patients with postoperative
fever was 5/15. In the control group, the BMI was (23.9±3.0) kg/m2, the diameter of
vaginal fistula was (0.8±0.5) cm, the
operative time of transvaginal repair was (99.9±19.7) min, the rate of associated genitourinary malformation was 2/60, the rate of multiple transvaginal repair was 18/60, the rate of concurrent ureteral
reimplantation was 5/60, and no postoperative
fever was found. Compared with the control group, the case group had higher BMI (P=0.013), bigger
vaginal fistula (P=0.002), longer time of operation (P=0.027), higher proportion of genitourinary malformations (P=0.013), higher proportion of repeated transvaginal repair (P < 0.001), higher proportion of ureter
reimplantation (P=0.006), and higher proportion of postoperative
fever (P < 0.001). Multivariate analysis showed that
fistula diameter ≥1 cm (OR=10.45, 95%CI=1.90-57.56, P=0.007) and repeated transvaginal repair (OR=16.97, 95%CI=3.17-90.91, P=0.001) were independent prognostic factors for VVF failure in transvaginal repair.
CONCLUSION: