Doctor! Will I be dry? Factors determining recurrence after vesicovaginal fistula repair.

OBJECTIVE To evaluate various prognostic factors which determine outcome after surgical repair of vesicovaginal fistula. METHODS The retrospective study was conducted at Koohi Goth Fistula Hospital, Karachi, and comprised data related to patients having undergone vesicovaginal fistula repair from January 2007 to June 2012. Multivariate analysis of the record was done using SPSS 19 software determining odds ratio with 95% confidence interval. RESULTS Record of 640 patients were analysed with an overall success in 558(87.2%) cases. Multivariate analysis determined that the recurrence of vesicovaginal fistula was significantly related to multiplicity (9-fold recurrence risk), pre-operative size (10-fold recurrence risk for fistula >2cm compared to <1cm), secondary repair (5-fold risk) and duration of the fistula (3-fold risk).Interposition of flap and delayed reconstruction (between 6 weeks and 1 year) was related to successful surgical outcome. Age, parity, aetiology, route of repair and location of fistula were not significant (p>0.05 each) prognostic factors for recurrence. CONCLUSIONS Successful surgical repair of vesicovaginal fistula require careful evaluation of various factors, including number, size, previous attempts to surgical repair and duration of fistula.