#0710

Dr. Why I am still not Dry --- Urodynamic changes after successful VVF repair

A. Abdullah¹

¹Liaquat National Hospital, Urology, Karachi, Pakistan

Introduction:

Surgical repair, whether through the vaginal or abdominal route, remains the only definitive treatment for vesicovaginal fistula (VVF), with success rates ranging from 85% to 95%. However, despite successful closure of the VVF, normal bladder function is not restored in a significant number of patients. Various studies have shown that, even after successful repair, stress urinary incontinence persists in 33% to 55% of cases. Approximately 50% of patients exhibit persistent detrusor instability. Other notable complications following successful VVF repair include vaginal stenosis with dyspareunia, persistent amenorrhea, and reduced bladder capacity. This study was designed to assess the functional outcomes of the urinary bladder following successful surgical closure of VVF.

Material and methods:

This was a prospective study conducted at the Urology Department of Liaquat National Hospital, Karachi, from March 2021 to 2023. All surgeries were performed by a single surgeon with over 15 years of experience and a special interest in VVF surgeries. Bladder function in the included patients was assessed using standard urodynamic studies, conducted 4 to 12 weeks after surgical repair. The study included patients with VVF who underwent their first successful surgical repair (both abdominal and vaginal approaches). Patients with a history of previous VVF repair, prior bladder surgery, bladder trauma, or neurogenic bladder were excluded from the study. Data was collected on patient age, etiology of the VVF, time between fistula formation and repair, bladder capacity post-repair, detrusor pressure post-repair, and the presence of stress or urge incontinence. The causes of VVF, the time interval between fistula formation and repair, bladder capacity, detrusor pressure, and the occurrence of stress or urge incontinence were carefully documented.

Results:

Bladder capacity was reduced in all cases of successful VVF repair, with a more pronounced decrease observed in patients with a fistula duration of over 6 months. Approximately 24% of patients experienced stress urinary incontinence, with the condition being more significant in cases of obstetric VVF. Detrusor instability, characterized by involuntary contractions, was observed in about 50% of the cases.