Urogenital fistula in the UK: a personal case series managed over 25 years

OBJECTIVE To review demography, aetiology, surgery and outcomes of women with urogenital fistula seen in one unit over the last 25 years; to provide data for comparison with a parallel study based on Hospital Episode Statistics. PATIENTS AND METHODS This is a prospective case series from a tertiary urogynaecology centre providing a de facto supra-regional fistula service. The women included had confirmed urogenital fistula referred between January 1986 and December 2010. Index cases were identified from a surgical database; data were entered prospectively and updated as appropriate; statistics are largely descriptive. The primary outcome is the patient's report of absence of urinary leakage. Secondary outcomes include operative or postoperative complications, anatomical closure of the fistula, other residual or new urinary symptoms, and the need for further intervention. RESULTS In all, 348 women with urogenital fistula were referred; two-thirds were of surgical aetiology, with almost half following hysterectomy. Although 11% followed childbirth, most of these followed operative obstetric interventions. Spontaneous closure occurred in 6.9% of women and 291 underwent surgical treatment. The anatomical closure rate at first operation was 95.7%, although 2.2% reported residual urinary incontinence. The success rates were similar regardless of aetiology, although successful fistula closure was significantly more likely in women who had not had attempts at closure before referral (98.2 vs 88.2%; Fisher's exact test; P = 0.003). CONCLUSION High rates of fistula closure are reported regardless of aetiology, although previous unsuccessful repair militates against successful outcome; this emphasises the appropriateness of centralisation of the management of this increasingly rare condition in UK practice.