The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service--a retrospective cohort study examining patterns of care between 2000 and 2008

OBJECTIVE: To estimate rates of vesicovaginal and urethrovaginal fistula among women undergoing hysterectomy by indication and type of procedure, and to assess trends in risk over time. DESIGN: Retrospective cohort using data from Hospital Episode Statistics. SETTING: English National Health Service (NHS) hospitals. POPULATION: Women undergoing hysterectomy for selected common conditions in English NHS hospitals between January 2000 and December 2008. METHODS: Unadjusted rates of urogenital fistula were calculated by type of procedure and indication. Logistic regression was used to assess whether the risk of fistula was associated with age, or had changed over time. MAIN OUTCOME MEASURE: Rate of urogenital fistula (vesicovaginal and urethrovaginal fistula) within 1 year of hysterectomy. RESULTS: Among 343 771 women undergoing hysterectomy, the overall rate of fistula was 1 in 788. The rate varied by indication and procedure, being highest following radical hysterectomy for cervical cancer (1 in 87; 95% CI 61-128) and lowest following vaginal hysterectomy for prolapse (1 in 3861; 95% CI 2550-6161). After total abdominal hysterectomy for endometriosis, menstrual problems or fibroids, the risk of fistula was lower in women aged 50 years or over than in women under 40 years (adjusted odds ratio 0.61; 95% CI 0.38-0.98). The overall rate of fistula increased by 46% during the study period. CONCLUSIONS: The risk of urogenital fistula was associated with type of hysterectomy and indication; the risk increased during the study period, and was lower after hysterectomy for benign conditions in women aged 50 years or over.