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Vesicovaginal fistula following pelvic surgery: Our experiences and recommendations for diagnosis and prompt referral.

BACKGROUND: Vesicovaginal fistula (VVF) is an uncommon but known complication of pelvic surgery. Post-operative urine leakage should generate a high index of clinical suspicion for early diagnosis of VVF.

AIMS: This study aims to identify areas for improvement and provide recommendations for timely and accurate diagnosis of VVF to minimise patient morbidity.

MATERIALS AND METHODS: A retrospective observational study of all patients who underwent VVF repairs unrelated to malignancies in a ten-year period at two primary referral centres in Brisbane was performed to review the aetiology, performance of investigative tests and management of these cases.

RESULTS: A total of 56 patients were studied with the identification of significant delays to diagnosis and referral, the performance of multiple unnecessary tests and low rates of primary surgeon referral.

CONCLUSIONS: Early recognition of VVF and assessment by outpatient methylene blue dye test can provide quick same-day diagnosis and minimise patient suffering. We hope this will alert gynaecologists and provide guidelines for diagnosis and improved management to allow for prompt referral and repair of genitourinary fistula.

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