Management of vesicovaginal fistulae: A multicenter analysis from the fellows' pelvic research network

Objectives: Vesicovaginal fistulae (VVF) are the most commonly acquired fistulae of the urinary tract, but we lack a standardized algorithmfor their management. The purpose of this multicenter study was to describe practice patterns and treatment outcomes of VVF in the United States. Methods: This institutional review boardYapproved multicenter review included 12 academic centers. Cases were identified using International Classification of Diseases codes for VVF from July 2006 through June 2011. Data collected included demographics, VVF type (simple or complex), location and size, management, and postoperative outcomes. χ², Fisher exact, and Student t tests, and odds ratios were used to compare VVF management strategies and treatment outcomes. Results: Two hundred twenty-six subjects were included. The mean age was 50 (14) years; mean body mass index was 29 (8) kg/m². Most were postmenopausal (53.0%), nonsmokers (59.5%), and white (71.4%). Benign gynecologic surgery was the caus for most VVF (76.2%). Most of VVF identified were simple (77.0%). Sixty (26.5%) VVF were initially managed conservatively with catheter drainage, of which 11.7% (7/60) resolved. Of the 166 VVF initially managed surgically, 77.5% resolved. In all, 219 subjects underwent surgical treatment and 83.1% of these were cured. Conclusions: Most of VVF in this series was managed initially with surgery, with a 77.5% success rate. Of those treated conservatively, only 11.7%resolved. Surgery should be considered as the preferred approach to treat primary VVF.