Long-Term Outcomes of Laparoscopic vs Open Vesicovaginal Fistula Repair

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.050

Nurupa Ramkissoon BS, Azure Erskine BS, MD (Candidate), Mikal Abraha BS, MD (Candidate), Kiara Lowery BS, MD (Candidate), Kamdili Ogbutor BS, MD (Candidate), Elijah McMillan BS, DPT, MD (Candidate), Da’Jhai Monroe BS, MD (Candidate), Ryan Mitchell BS, MD (Candidate), Tajah Lewter BS, MD (Candidate), Samwarit Zinabu MD, Miriam Michael MD

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引用次数: 0

Abstract

Introduction

Vesicovaginal fistula (VVF) is a debilitating condition that can lead to urinary incontinence and impaired quality of life. Laparoscopic repair has emerged as a minimally invasive alternative to traditional approaches, but its impact on postoperative continence remains unclear. This study evaluates the one-year outcomes of incontinence in patients undergoing laparoscopic versus non-laparoscopic VVF repair.

Methods

A retrospective cohort study was conducted on 768 propensity-matched patients who underwent VVF repair, with 384 receiving laparoscopic repair and 384 undergoing non-laparoscopic repair. Groups were matched by age and race. Risk analysis, Kaplan-Meier survival analysis, and t-tests were performed to compare incontinence rates, time-to-incontinence, and severity between cohorts.

Results

Patients in the laparoscopic group had a significantly lower incontinence rate (3.6%) compared to the non-laparoscopic group (10.2%) (p = 0.000). The risk ratio (0.359) and odds ratio (0.335) indicated a substantial reduction in incontinence risk with laparoscopic repair. Kaplan-Meier analysis showed a significantly higher continence survival probability (96.1% vs. 88.98%, p = 0.000). The hazard ratio (0.353) suggested a 65% lower risk of incontinence over time, though proportionality testing was non-significant (p = 0.466). Incontinence severity was also significantly lower in the laparoscopic group (p = 0.007).

Conclusion

Laparoscopic VVF repair is associated with a significantly lower risk and severity of incontinence, with prolonged continence survival. These findings suggest that laparoscopic repair should be considered the preferred approach when feasible. Further studies are needed to assess long-term outcomes and patient quality of life.

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腹腔镜与开放式膀胱阴道瘘修复的远期疗效

膀胱阴道瘘（VVF）是一种使人衰弱的疾病，可导致尿失禁和生活质量受损。腹腔镜修复已成为传统方法的一种微创替代方法，但其对术后尿失禁的影响尚不清楚。本研究评估了腹腔镜与非腹腔镜VVF修复患者尿失禁的一年结果。方法对768例倾向匹配的VVF修复患者进行回顾性队列研究，其中384例接受腹腔镜修复，384例接受非腹腔镜修复。各组按年龄和种族进行匹配。进行风险分析、Kaplan-Meier生存分析和t检验，比较各组之间的尿失禁率、尿失禁时间和严重程度。结果腹腔镜组患者尿失禁率（3.6%）明显低于非腹腔镜组（10.2%）（p = 0.000）。风险比（0.359）和优势比（0.335）表明腹腔镜修复术大大降低了尿失禁的风险。Kaplan-Meier分析显示尿失禁生存率显著高于对照组（96.1% vs. 88.98%, p = 0.000）。风险比（0.353）表明，随着时间的推移，尿失禁的风险降低了65%，尽管比例检验无显著性（p = 0.466）。腹腔镜组尿失禁严重程度也明显降低（p = 0.007）。结论腹腔镜VVF修复术可显著降低尿失禁风险和严重程度，延长尿失禁生存期。这些结果表明，在可行的情况下，腹腔镜修复应被视为首选方法。需要进一步的研究来评估长期结果和患者的生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.