POSTHYSTERECTOMY VAGINAL CUFF FISTULA - DIAGNOSIS AND MANAGEMENT OF AN UNUSUAL CAUSE OF INCONTINENCE

Objectives. Connection between the vaginal cuff and the peritoneal cav ity after hysterectomy is a rare event that can mimic urinary incontin ence. The appropriate evaluation and treatment of these patients is di scussed. Methods, Five patients underwent excision of the vaginal cuff during a 12-month period. All of these patients had a negative workup for urinary incontinence, except for 1 patient who also had stress in continence and required a vaginal wall sling at the time of cuff excis ion. Results. All 5 patients are presently free of excess vaginal drai nage or significantly improved, with a mean follow-up of 6 months. One patient developed stress incontinence after cuff excision and later r equired a vaginal wall sling. There have been no perioperative complic ations and no evidence of recurrent fistula, Conclusions. Fistula of t he vaginal cuff is a diagnosis of exclusion after urinary incontinence has been ruled out. A high index of suspicion is often required to ma ke the diagnosis because these patients often present with symptoms hi ghly suggestive of urinary leakage. Fistula of the vaginal cuff is suc cessfully treated with excision of the vaginal cuff and the fistulous tract (if identified), with minimal morbidity. (C) 1998, Elsevier Scie nce Inc. All rights reserved.