Management of urinary fistulas due to midurethral sling surgery

Jerry G. Blaivas, Gabriel Mekel

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Purpose We report our experience with the diagnosis and treatment of women with urinary fistula after mid urethral sling surgery. Materials and Methods We retrospectively reviewed the records of patients with urinary fistula secondary to mid urethral sling surgery. Electronic medical records and billing records were searched. We analyzed sling type, presenting symptoms and interval from initial sling surgery to 1) symptom appearance, 2) fistula diagnosis and 3) fistula repair. Symptomatic outcomes were assessed by PGI-I. Surgical outcomes were based on history and examination. Results We identified 10 women with a mean age of 58 years (range 37 to 70). Mean interval from mid urethral sling surgery to symptom onset, diagnosis and fistula repair was 2, 16 and 18 months, respectively. Mean followup was 26 months (range 4 to 96). There were 1 ureterovaginal, 1 enterovesical, 6 vesicovaginal and 7 urethrovaginal fistulas. Patients presented with stress urinary incontinence (70%), unaware incontinence (50%), overactive bladder (40%), pelvic pain (30%) and voiding symptoms (20%). Nine women underwent fistula repair and 1 underwent continent urinary diversion. A Martius flap was used in 6 of 9 patients, an omental flap and a bladder wall flap were used in 2 each, urethral reconstruction and ureterocolovesicostomy were performed in 1 each and 7 received an autologous pubovaginal sling. Seven patients (78%) underwent successful fistula repair. A successful symptomatic outcome was achieved in 5 of 7 women with stress urinary incontinence, 3 of 5 with unaware incontinence, 3 of 4 with overactive bladder, 2 of 3 with pelvic pain and 2 of 2 with voiding symptoms. Conclusions With careful attention to surgical principles and technique, including removal of as much of the adjacent mesh as possible, a successful outcome can be achieved in most patients with a fistula secondary to mid urethral sling surgery.

Original languageEnglish
Pages (from-to)1137-1142
Number of pages6
JournalJournal of Urology
Volume192
Issue number4
DOIs
StatePublished - 1 Oct 2014
Externally publishedYes

Keywords

  • fistula
  • postoperative complications
  • suburethral sling
  • surgical mesh
  • urethra

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