Current techniques for vesicovaginal fistula repair: Surgical pearls to optimize cure rate

Abstract

Vesicovaginal fistulas (VVFs) are a devastating consequence of prolonged labor in developing countries and pelvic surgery in developed countries. Clinical history, physical examination, and pertinent radiographic studies are necessary for proper diagnosis. Endoscopic management can lead to successful closure of small fistulas; the advent of tissue bioglues has made this modality more promising. However, the majority of patients will require transvaginal or transabdominal repair of the fistula. This article reviews the basic principles of fistula closure and discusses adjuvant techniques with tissue interposition grafts; techniques for successful closure of fistulas; and newer modalities for repair using tissue bioglues, laparoscopy, and robotic surgery.

Use of Pedicled Omental Graft as an Aid to Vesicovaginal Fistula Repair

“…In comparison with our first study the number one cause of VVF is now trauma during hysterectomy. 10 Fistulae are now classified into three groups, firstly, in the obstetric field, majority were due to pressure necrosis due to obstructed labor followed by forceps delivery and cesarean hysterectomy. Secondly the surgical causes were mainly due to hysterectomies.…”

Transvaginal genital fistula repair with insertion of Foley catheter via fistula tract

“…Various methods of genital fistula repair have been described in the literature including open transabdominal, transvaginal and laparoscopic approaches, depending on the characteristics of the fistula, and the preference and experience of the surgeon. These are not widely practiced, however, due to the costs and considerable learning curve required for extracorporeal freehand suturing . Raashid et al .…”

“…These are not widely practiced, however, due to the costs and considerable learning curve required for extracorporeal freehand suturing. 7,[11][12][13][14][15] Raashid et al noted that, for transabdominal or transvaginal approaches, the success rate of VVF repair surgery was only 87%. 16 The vaginal approach is our first choice for fistula repair, because it is a fast, minimally invasive procedure with low morbidity, minimal blood loss, and short hospital stay.…”

Transvaginal neobladder vaginal fistula repair after radical cystectomy with orthotopic urinary diversion in women

“…Instead of creating this second layer, we advocate tissue interposition between the neobladder and the vagina to achieve a successful repair. The interposition of a Martius flap allows a better epithelization surface, extra vascularization of a possibly ischemic zone and better lymphatic drainage, as well as avoidance of an overlapping suture line . Using this technique, we successfully treated three patients with fistulas measuring more than 2 cm in diameter, two patients with recurrent fistulas after two prior vaginal repairs and six patients with vaginal atrophy.…”