Management of urinary fistulas due to midurethral sling surgery

Jerry G Blaivas, Gabriel Mekel
Journal of Urology 2014, 192 (4): 1137-42

PURPOSE: We report our experience with the diagnosis and treatment of women with urinary fistula after mid urethral sling surgery.

MATERIALS AND METHODS: We retrospectively reviewed the records of patients with urinary fistula secondary to mid urethral sling surgery. Electronic medical records and billing records were searched. We analyzed sling type, presenting symptoms and interval from initial sling surgery to 1) symptom appearance, 2) fistula diagnosis and 3) fistula repair. Symptomatic outcomes were assessed by PGI-I. Surgical outcomes were based on history and examination.

RESULTS: We identified 10 women with a mean age of 58 years (range 37 to 70). Mean interval from mid urethral sling surgery to symptom onset, diagnosis and fistula repair was 2, 16 and 18 months, respectively. Mean followup was 26 months (range 4 to 96). There were 1 ureterovaginal, 1 enterovesical, 6 vesicovaginal and 7 urethrovaginal fistulas. Patients presented with stress urinary incontinence (70%), unaware incontinence (50%), overactive bladder (40%), pelvic pain (30%) and voiding symptoms (20%). Nine women underwent fistula repair and 1 underwent continent urinary diversion. A Martius flap was used in 6 of 9 patients, an omental flap and a bladder wall flap were used in 2 each, urethral reconstruction and ureterocolovesicostomy were performed in 1 each and 7 received an autologous pubovaginal sling. Seven patients (78%) underwent successful fistula repair. A successful symptomatic outcome was achieved in 5 of 7 women with stress urinary incontinence, 3 of 5 with unaware incontinence, 3 of 4 with overactive bladder, 2 of 3 with pelvic pain and 2 of 2 with voiding symptoms.

CONCLUSIONS: With careful attention to surgical principles and technique, including removal of as much of the adjacent mesh as possible, a successful outcome can be achieved in most patients with a fistula secondary to mid urethral sling surgery.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"