Extended bladder catheterization for women with positive dye tests after obstetric vesicovaginal fistula repair surgery

• Published in: International journal of gynecology and obstetrics Vol. 149; no. 1; pp. 61 - 65
• Main Authors: Chang, Olivia H., Ganesh, Prakash, Wilkinson, Jeffrey P., Pope, Rachel J.
• Format: Journal Article
• Language: English
• Published: United States 01-04-2020
• Subjects: Bladder catheterization; Failed fistula repair; Fistula repair; Obstetric fistula; Vesicovaginal fistula; Fistula repair; Failed fistula repair; Vesicovaginal fistula; Obstetric fistula; Bladder catheterization
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.13088

Objective
To determine the success rate and factors that result in a negative dye test after extended bladder catheterization after surgery for obstetric fistula.
Methods
A retrospective cohort study was carried out on women who underwent obstetric fistula repair in Malawi and had ≥14 days of bladder catherization. Variables such as age, class of fistula, previous repairs, menopausal status, and HIV status were examined for association with successful healing at the end of the catheterization period.
Results
Fifty‐two patients had a positive dye test after the intended period of catheterization and the catheterization period was extended by 7 days. Of these patients, 29 (55.7%) had a subsequent negative dye test. Older women (mean age 28.4 years) who developed a fistula were more likely to have a negative dye test after extended catheterization, compared to their younger counterparts (mean age 20 years) (P=0.0018). Other variables were not found to be significantly different between the two groups.
Conclusion
More than half of the patients with a positive dye test had complete closure of the fistula defect after an extension of bladder decompression. It is reasonable to consider an extension of bladder catheterization for 7 days after an initial positive dye test.
After a failed vesicovaginal fistula surgery, it is reasonable to consider extending bladder catheterization for 7 days.