Early Versus Late Repair of Vesicovaginal Fistulas: Vaginal and Abdominal Approaches

Abstract

We reviewed retrospectively 24 consecutive women who presented with a vesicovaginal fistula repaired by a single surgeon between 1989 and 1993. All patients underwent preoperative investigation, including cystoscopy, excretory urography and bilateral retrograde pyelography. Followup ranged from 6 months to 5 years. Postoperatively, 96% of the women were cured. Two patients had persistent symptomatic detrusor instability and 1 had mild stress incontinence. In 1 woman a vaginal repair failed and she was subsequently cured after an abdominal repair. Five patients presented 6 to 12 months after fistula formation. Among the other 17 patients the average interval from pelvic surgery to vesicovaginal fistula repair was 10.8 weeks. Indications for abdominal repair were indurated vaginal epithelium approximately 2 cm. in circumference around the fistula, a vault fistula with poor vaginal exposure and fistulas involving the ureters. Surgical timing and route of repair are best tailored to the individual patient.

Eighteen Years Old Vesico-Vaginal Fistula Caused by Forceps Delivery: A Saga of Suffering

“…All obstetric fistulas should be repaired at least 3 months after delivery to allow edema and inflammation to subside. While excellent results have been reported by early repair by some surgeon 8,9 , it may not be appropriate in all cases. In our society many such women are neglected and malnourished, suffering from untreated urinary infections and anemia.…”

Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

“…Most vesicovaginal fistulae are the result of pelvic surgeries, wherein 90% occur after hysterectomy (1)(2)(3)4,6).…”

“…The decision between transvaginal and transabdominal approaches depends on the location of the fistula, its relationship with the ureteric orifice and the time between fistula formation and repair (3). The advantages of early vs. delayed repair are still debatable (4). The effectiveness of surgical correction of large fistulae has been described as ranging from 75% to 97% (3,5,6).…”

“…Once the fistula is identified, the vesicovaginal space is dissected to separate the structures; the importance of this technique lies in the intentional cystotomy for localizing the tract. The laparoscopic approach is primarily associated with similar success rates, minimal surgical trauma and reduced morbidity, allowing for more rapid convalescence (4,8,(10)(11)(12)(13)(14)(15)(16). Despite initial enthusiasm, laparoscopy has not gained popularity, most likely because laparoscopic VVF dissection and intracorporeal suturing are technically challenging.…”

Vesicovaginal fistula: what is the preferred closure technique?

“…A surgeon will not become expert if exposed only to the occasional fistula. Ideally, the experienced VVF surgeon would be skilled in vaginal and abdominal techniques and have a relatively high volume of exposure, allowing for optimal informed consent and a flexible, tailored approach suitable to the specific VVF architecture and level of complexity [11].…”