Vaginal complications afflict many women after cystectomy

Vaginal complications occur more frequently than expected among women who undergo cystectomy, reports a study. More than one in five women, as well as over a quarter of those diagnosed undergoing intervention, experience such a complication.

The authors conducted this study to estimate the incidence of vaginal complications (characterized by vaginal prolapse, vaginal fistula, dyspareunia, and vaginal cuff dehiscence/evisceration) following cystectomy and to identify risk factors for these problems.

Procedural codes in the Medicare Limited Data Set 5-percent sample from 1 January 2011 to 31 December 2017 were used to identify patients aged ≥65 years who underwent cystectomy for any indication. Women who experienced a complication were compared to those who did not.

The authors determined demographic and biological factors that could raise the odds of complications, as well as time to development. Finally, they used multivariable cause-specific Cox proportional hazards model to assess risk factors for vaginal complications.

A total of 481 women were included in the study, of whom 37.2 percent were younger than 70 years old. Majority had bladder cancer (n=378, 79 percent), and most patients (n=401, 83.4 percent) underwent an incontinent conduit or catheterizable channel diversion.

Ninety-three women (19.5 percent) developed at least one complication on record within 2 years of cystectomy. The most common problem was vaginal cuff dehiscence, which occurred in 49 patients (10.2 percent).

From 2011 to 2017, 102 women (21.2 percent) were diagnosed with a vaginal complication, but only 27 (5.6 percent) received an intervention.

“Cystectomy with a vaginal-sparing approach may be associated with unique complications specific to the female population,” the authors said.