Spontaneous closure of vesicovaginal fistulas after bladder drainage alone: review of the evidence

Abstract

A vesicovaginal fistula may occur as a surgical complication, the result of obstructed labor, or a late manifestation of radiotherapy. Surgical treatment includes many routes and techniques, with a success rate reaching 100%. The spontaneous closure of vesicovaginal fistulae following [corrected] bladder drainage alone for varying periods has been reported by many. The factors favoring the success of this conservative method have not been well examined [corrected] In this investigation [corrected] all articles referring [corrected] to this modality were reviewed [corrected] The parameters studied included etiology, size, interval from [corrected] causative insult to drainage, and duration of drainage. The incidence of spontaneous closure of fistulae [corrected] after bladder drainage alone ranged between [corrected] 0 and 100%. Among all assessed criteria, the interval to drainage seems to have the best correlation with success. This finding [corrected] is most likely explained on the basis of the epithelialization of the fistulous tract with time, preventing spontaneous healing. In the view of the retrospective nature of the reviewed articles, the absence of a detailed classification system, and the heterogeneity of the treatment in question, no solid conclusion regarding management recommendations can be drawn.

Spontaneous closure of urethrovaginal fistula associated with pelvic fracture

“…In the cases of fistulas formed due to obstetric or gynecological injuries, spontaneous healing is described in the literature, especially in those cases where the fistula is small and early, with prolonged bladder drainage is provided. [6] Our case does bring out a fact that is less emphasized in the medical teaching that while persistence of fistula is often attributed to the distal obstruction, closure of fistula does not necessarily mean restoration of normal anatomy but could be a development of proximal obstruction. To the best of our knowledge, we are describing the first case of spontaneous closure of the urethrovaginal fistula associated with pelvic fracture.…”

An uncommon case of inflammatory infiltration of the urinary bladder in the long–term process of the purulent inflammation of the cervix and vaginal fornix, complicated with vesicovaginal fistula of unknown etiology

“…The spontaneous closure of VVF without surgical intervention has already been encountered in clinical practice [5]. In this case, it took six months until the fistula was reduced from 1.5 cm to 1–2 mm.…”

Is the Simple Closure Technique Effective in the Treatment of Genital Fistulas?

“…However, the underlying pathophysiology can be identified in almost all cases. Ischemic necrosis of the tissues is the main reason of the fistula formation, hence, obstructed prolonged labor due to unattended deliveries, small pelvic dimensions, malpresentation, poor uterine contractions, introital stenosis, gynecologic surgery, radiation therapy, infectious disease such as lymphogranuloma venereum, tuberculosis, syphilis, bladder stones, retained foreign body in the vagina, obstetrical injury, complications of episiotomy, adolescent deliveries, malnutrition, forceps or vacuum applications, Crohn's disease could lead to genital fistulas [4–6]. Our study showed that obstetrical factors have been responsible for the majority of cases.…”

“…Other reasons include radiation, inflammatory bowel disease, pelvic operations, forceful coitus, and neoplasms. The exact incidence of genital fistulas which is directly related to the socioeconomic level of the affected population is unknown due to data inadequacy in the developing world [2–4]. Genital fistulas can be treated via abdominal or vaginal routes.…”