ObjectiveTo investigate long-term and patient-reported outcomes, including sexual
function, in women undergoing urogenital fistula (UGF) repair, addressing the lack
of such data in Western countries, where fistulas often result from iatrogenic causes.Patients
and MethodsWe conducted a retrospective analysis at a tertiary referral centre (2010-2023),
classifying fistulas based on World Health Organisation criteria and evaluating surgical
approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention
rates) and subjective outcomes (validated questionnaires) were assessed. A scoping
review of patient-reported outcome measures in UGF repair was also performed.ResultsThe
study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal
surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile
range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in
94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after
three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress
urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported
outcomes showed median (IQR) scores on the International Consultation on Incontinence
Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7)
for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence
symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with
Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR)
ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item
score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher
symptom burden and treatment satisfaction, respectively. Our scoping review included
1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity,
thus complicating cross-study comparisons.ConclusionsUrogenital fistula repair at
a specialised centre leads to excellent outcomes and high satisfaction. Patients with
urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly
due to the original trauma site of the fistula.
