Author(s): Hilton P, Cromwell D
Abstract: 0 0 1 246 1404 Newcastle Upon Tyne Hospitals NHS Foundation Trust 11 3 1647 14.0 Normal 0 false false false EN-GB JA X-NONE Objective To estimate rates of vesico-vaginal and urethro-vaginal fistula among women undergoing hysterectomy by indication and type of procedure, and assess trends in risk over time. Design: Retrospective cohort using data from Hospital Episode Statistics. Setting English National Health Service (NHS) hospitals. Population Women undergoing hysterectomy for selected common conditions in English NHS hospitals between January 2000 and December 2008. Methods Unadjusted rates of urogenital fistula were calculated by type of procedure and indication. Logistic regression was used to assess whether the risk of fistula was associated with age, or had changed over time. Main outcome measure Rate of urogenital fistula (vesico-vaginal and urethro-vaginal fistula) within one year of hysterectomy. Results Among 343,771 women undergoing hysterectomy, the overall rate of fistula was 1 in 788. The rate varied by indication and procedure being highest following radical hysterectomy for cervical cancer (1 in 87; 95% CI: 61 to 128) and lowest following vaginal hysterectomy for prolapse (1 in 3861; 95% CI: 2550 to 6161). After total abdominal hysterectomy for endometriosis, menstrual problems or fibroids, the risk of fistula was lower in women aged 50 years or over than women under 40 years (adjusted odds ratio 0.61; 95% CI 0.38 to 0.98). The overall rate of fistula increased by 46% during the study period. Conclusion The risk of urogenital fistula was associated with type of hysterectomy and indication; the risk increased during the study period, and was lower after hysterectomy for benign conditions in women aged 50 years or over.
Keywords: urinary fistula; vesicovaginal fistula; hysterectomy; intraoperative complications; postoperative complications; surgical injuries