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. 2007 Oct;23(4):372-6.
doi: 10.4103/0970-1591.36709.

Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach

Rakesh Kapoor  1 , M S Ansari, Pratipal Singh, Parag Gupta, Naval Khurana, Anil Mandhani, Deepak Dubey, Aneesh Srivastava, Anant Kumar
Affiliations

Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach

Rakesh Kapoor et al. Indian J Urol. 2007 Oct.

Abstract

Purpose: We aim to present our experience for the repair of vesicovaginal fistula (VVF) with special reference to surgical approach.

Materials and methods: From January 1999 to June 2005, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms.

Results: Thirty-two (61.5%) had simple fistulas and 20 (38.5%) complex fistulas. The most common etiology was obstetric trauma in 31 (59.6%) patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5%) patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5%) patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2%) patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2%) complained of mild to moderate dyspareunia.

Conclusion: Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates.

Keywords: Fistula; management; tuberculosis; vesicovaginal.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Traction on a small-sized Foley catheter, which is passed into the bladder through the fistulous opening, helps to bring the fistula closer to the view
Figure 2
Figure 2
Martius flap raised, which was used as interpositional flap in transvaginal repair
Figure 3
Figure 3
Algorithm for the treatment of VVF
See this image and copyright information in PMC

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