https://doi.org/10.4081/uij.2023.313

Prevalent practices and changing trends in the management of vesicovaginal fistula: a cross-sectional study from a nationwide questionnaire-based survey of urologists from a developing country

Vol. 35 No. 1 (2023)
Submitted: 14 June 2023
Accepted: 18 October 2023
Published: 26 October 2023
Vesicovaginal fistula, complications, survey, changing trends, management, evidence
Abstract Views: 468
PDF: 218
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Authors

Anupam Choudhary
https://orcid.org/0000-0002-9868-9269
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
Anshuman Singh
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
Suyog Shetty
https://orcid.org/0000-0003-3784-8016
Department of Urology, Father Muller Medical College, Father Muller Charitable Institutions, Mangaluru, Karnataka, India.
Surag K.R.
surag244@gmail.com
https://orcid.org/0000-0002-7314-094X
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
Manjunath Irappa Wali
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
Arun Chawla
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
Padmaraj Hegde
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
Bommireddy V. Reddy
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
Goli Venkata Sai Abhishek
https://orcid.org/0000-0002-8411-7235
Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.

Vesicovaginal fistula (VVF) management is primarily backed by evidence from retrospective studies and expert opinions and therefore lacks standardization. Newer generations of surgeons are more proactive toward changing clinical practices in domains lacking good-quality evidence. This survey-based cross-sectional study aims to elicit consensus on management practices regarding various domains of VVF management and look for any changes in clinical practice trends. A nationwide survey of urologists was conducted, and responses were grouped into 3 categories (overall response, response from young urologists, and response from experienced urologists) and compared. Based on the level of overall consensus, the responses were categorized as highly preferred, preferred, and somewhat preferred. Consensus was noted in conservative and endoscopic management of VVF, timing of VVF repair, definition of simple/complex VVF, approach for surgical repair for trigonal and supratrigonal VVF, use of interposition tissue for repair, and patient positioning in the postoperative period. A lack of consensus was noted in other domains. Changing trends in clinical practices were noted in attempts at conservative and endoscopic management, investigations considered mandatory for evaluation, surgical approach for complex VVF with bladder neck involvement and radiation-induced fistulas, the use of interposition grafts during surgical repair, the use of cystograms during follow-up, and the definition of a successful repair. There is uniformity in practices regarding many domains of VVF management. Those areas, where discordance in opinions is noted, require further research to bring standardization into practice. Regarding certain aspects of VVF management, there appears to be a change in trends among the younger generation of urologists.

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How to Cite

Choudhary, A., Singh, A., Shetty, S., K.R., S., Wali, M. I., Chawla, A., Hegde, P., Reddy, B. V., & Abhishek, G. V. S. (2023). Prevalent practices and changing trends in the management of vesicovaginal fistula: a cross-sectional study from a nationwide questionnaire-based survey of urologists from a developing country. Urogynaecologia, 35(1). https://doi.org/10.4081/uij.2023.313
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