Preoperative and postoperative urodynamics in patients with vesicovaginal fistulas.

Background: Several voiding abnormalities been seen to persist in women even after successful repair of vesicovaginal fistula (WF). Aims and Objectives: To establish the occurrence, incidence and type of voiding dysfunction in patients with WFs and the impact of repair of fistula on it. The fistulas were classified into type II (involving the closing mechanism) and type I (involving the closing mechanism) as per Waaldijk classification. Materials and Methods: Preoperatively urodynamic study was done in all 35 patients while in the postoperative period it was done only in 18 patients as five patients were lost to follow up and twelve patients denied consent for urodynamic study. Results: Preoperatively urodynamic SUI (n=6), detrusor instability (n=5), impaired bladder compliance (n=16) and voiding dysfunction (n=22) were noted. In the postoperative period too urodynamic SUI (n=l), detrusor instability (n=2), impaired bladder compliance (n=4), voiding dysfunction of hypotonic detrusor type(n=2) and obstructive voiding(n=2) were seen. The comparison of various urodynamic diagnoses between type I and type II fistulas preoperatively and postoperaively revealed a significant difference only in urodynamic SUI preoperatively (p=0.0118). Postoperatively five patients had a cystometric capacity less than 200 ml. The difference between various patient, fistula and treatment related factors in patients with and without urodynamic abnormalities was not statistically significant. Conclusions: Our study suggests that voiding abnormalities are quite common at short term follow up in patients with WF but whether they persist in long term needs to be seen. Also the findings in pre-operative urodynamic study did not always correlate with those in post-operative period. [ABSTRACT FROM AUTHOR]