Urinary fistulas: What does the evidence say?

Abstract

Urinary fi stulas are well-recognized, iatrogenic complications in developed countries that require timely diagnosis and tailored management. Vesicovaginal fi stula (VVF) is the most common type of urinary fi stula. Depending on the size, mechanism of injury, time of discovery, evidence of active infl ammation, and experience of the surgeon, a wide range of treatment options exist for VVF. Most fi stulas can be promptly repaired transvaginally, with high success rates at the time of diagnosis unless there are ongoing infl ammatory processes. Tissue interposition and surgical approach should be guided by individual case. The role of novel techniques for urinary fi stula repair-such as laparoscopic-assisted approach, endoscopic fulguration, and use of fi brin glue-is still being defi ned and currently has limited application. This article reviews the current literature and establishes guidelines for the evaluation and management of VVF.