Repair of Giant Vesicovaginal Fistulas

Abstract

A combined abdominovaginal approach with the use of a generous rotational bladder flap for repair of a complex vesicovaginal fistula allowed for excellent results. There was a high success rate on the first attempt due to the excellent exposure and healthy, well vascularized tissue used for repair.

Repair of complex vesicovaginal fistulas by combining a rotational bladder flap and full thick vascular peritoneal interposition

“…Further, according to Christopher, this method of repair has the potential disadvantage of an increase in voiding dysfunction and a decrease in bladder capacity. The follow‐up results of our patients indicated that normal bladder capacity was achieved in approximately 3 months post‐operatively, which is consistent with reported studies . Generally, the incidence of voiding dysfunction could be kept at a relatively low level.…”

“…One of 18 patients had urinary frequency and nocturia in our study. By way of the rotational bladder flap repair, the incidence of voiding dysfunction was 6 of 34 and 0/9 in studies conducted by Ezzat et al and Sharifiaghdas et al, respectively. In fact, the urinary dysfuntion problem was not only attributed to the transabdominal repair.…”

“…In 2006, Dalela et al performed the technique without retropubic gap separation and anterior bladder wall incision, with a success rate of 100% (26/26). The modified O'Connor repair was used by Ezzat et al in the US and Sharifiaghdas et al in Iran, with success rates of 90% (9/10) and 88% (31/35), respectively. In our study, because all of the fistulas were located in the trigonal or supratrigonal region (two in primary cases and three in recurrent cases had bladder dome‐located fistulas).…”

Repair of vesicovaginal fistula by the transabdominal route: outcome at a north Indian tertiary hospital

“…The fistula margin is circumferentially dissected and a plane between the bladder wall and vaginal wall is created [16][17][18][19]. Vascularized interposition flaps are highly effective in reinforcing the suture lines.…”

“…Stents should be inserted in both the ureters prior to the lateral and superior mobilization and dissection of the bivalved bladder walls [16][17][18][19][20]. Our technique is similar to the O'Connor technique and is mentioned in the operative technique in the "Material and methods" Section.…”