Genito-urinary fistulae (GUF) are relatively uncommon in the developed world and are more commonly associated with an iatrogenic aetiology. Much of our knowledge on the surgical treatment of this problem is borne out of individual case series, with very few publications that involve high patient numbers. In the UK genito-urinary fistuale are increasingly being treated in tertiary centres with higher volumes of cases. We report on the outcomes of genito-urinary fistula repair in a single high-volume regional referral centre.

We performed a retrospective review of patient records, operation notes and radiology results of all female patients who underwent GUF repair in our unit over a 15 year period. Preoperative data included fistula aetiology, time-to-surgery and number of previous attempts at repair.  Repairs were performed using a trans-abdominal approach for fistulae that were large, located towards the dome of the bladder or involved either the ureter(s) or uterus.  Repair was performed using non-overlapping suture lines and tissue interpositioning was achieved using the omentum where available, peritoneum or a Martius fat pad during a trans-vaginal repair.  Catheter removal was performed following an absence of contrast extravasation during a cystogram at the 2nd post-operative week. Outcome assessments include complications, anatomical closure rates, and continence rates.

A total of 95 patients were identified; all were tertiary referrals.  Of these 35 (36.8%) had at least one prior repair attempt at another centre. The mean age was 49.9 years. Median time from creation of the fistula to repair was 12 months (range 1 week – 27 years). Most fistulas occurred following transabdominal hysterectomy (46.3%) followed by obstetric complications (12.6%).  The majority of patients underwent a transabdominal approach (72.6%); of these 94.2% had an omental interposition graft and the remainder a peritoneal interposition graft.  96.2% of patients who underwent transvaginal repair had a martius graft. One patient had a persistent fistula post-operatively and two developed a recurrence >2 years after initial repair.  Twenty-two patients (23.2%) developed stress urinary incontinence (SUI); more commonly following the transvaginal approach. Thirteen of these patients proceeded to SUI surgery (1 transvaginal tape insertion, 12 autologous rectus fascial sling insertion), all thirteen were continent post-operatively. The remainder had mild SUI which was successfully managed conservatively. There were no Clavian-Dindo complications >Grade 3.

In our centre the success rate of surgical repair of  genito-urinary fistula repair was 98.9%, even in cases of complex or re-do repair. There were two recurrences of fistulae after two years.

It is important that patients with GUF are treated in a centre with appropriate expertise and preferably a high volume of cases. Stress urinary incontinence is the most common post-operative complication, particularly after the transvaginal approach however can be successfully managed.