Abstract
A vaginal fistula is defined by extra-anatomic communication between the vaginal and an epithelial lined organ. This communication in the vagina may be straight forward with an abnormal connection to and involve the ureters, bladder, urethra, and rectum. A complex vaginal fistula might involve several different abdominal and pelvic organs which emphasize the importance of a complete workup before attempting to repair. A vaginal fistula negatively affects an individual’s quality of life and prompt repair is suitable in most patients that are properly selected. There are many surgical approaches to repair a fistula, the best repair centers on the first procedure being the most effective. However, there is a lack of high quality comparative studies to guide the surgeon. When selecting the initial surgical approach, the surgeon should consider their expertise and experience after a thorough evaluation to determine the etiology and location of the fistula. In this chapter we will focus on the etiology, diagnosis, evaluation, and surgical repair of vesicovaginal, urethrovaginal, and rectovaginal fistula.
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References
Shelbaia AM, Hashish NM. Limited experience in early management of genitourinary tract fistulas. Urology. 2007;69:572.
Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153:1110.
Rutman MP, Raz S, Rodriguez LV. Female urology. 3rd ed. Philadelphia: Elsevier; 2008. p. 794–801.
Pushkar DY, Sumerova NM, Kasyan GR. Management of urethrovaginal fistulae. Curr Opin Urol. 2008;18:389.
Ricart E, Panaccione R, Loftus EV, et al. Infliximab for Crohn’s disease in clinical practice at the Mayo Clinic: the first 100 patients. Am J Gastroenterol. 2001;96:722.
Sands BE, Blank MA, Patel K, et al. Long-term treatment of rectovaginal fistulas in Crohn’s disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol. 2004;2:912.
Present DH, Korelitz BI, Wisch N, et al. Treatment of Crohn’s disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med. 1980;302:981.
Present DH, Lichtiger S. Efficacy of cyclosporine in treatment of fistula of Crohn’s disease. Dig Dis Sci. 1994;39:374.
Eilber KS, Kavaler E, Rodriguez LV, et al. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169:1033.
Richman MB, Goldman HB. Vesicovaginal fistula: abdominal approach. In: Vasavada SP, Appell RA, Sand PK, Raz S, editors. Female urology, urogynecology, and voiding dysfunction. New York: CRC; 2005. p. 783–95.
Gupta NP, Mishra S, Hemal AK, et al. Comparative analysis of outcome between open and robotic surgical repair of recurrent supra-trigonal vesico-vaginal fistula. J Endourol. 2010;24:1779.
Abdel-Karim AM, Mousa A, Hasouna M, et al. Laparoscopic transperitoneal extravesical repair of vesicovaginal fistula. Int Urogynecol J. 2011;22:693.
Gozen AS, Teber D, Canda AE, et al. Transperitoneal laparoscopic repair of iatrogenic vesicovaginal fistulas: Heilbronn experience and review of the literature. J Endourol. 2009;23:475.
D’Ambrosio G, Paganini AM, Guerrieri M, et al. Minimally invasive treatment of rectovaginal fistula. Surg Endosc. 2012;26:546.
Arrowsmith SD. Genitourinary reconstruction in obstetric fistulas. J Urol. 1994;152:403.
Evans DH, Madjar S, Politano VA, et al. Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology. 2001;57:670.
Carr LK, Webster GD. Full-thickness cutaneous martius flaps: a useful technique in female reconstructive urology. Urology. 1996;48:461.
Wee JT, Joseph VT. A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report. Plast Reconstr Surg. 1989;83:701.
Wang Y, Hadley HR. The use of rotated vascularized pedicle flaps for complex transvaginal procedures. J Urol. 1993;149:590.
Gerges DG, Mesfen W. [Repair of a complex vesicovaginal fistula using a musculocutaneous flap of the gracilis muscle]. J Urol (Paris). 1984;90:491.
Ayed M, El Atat R, Hassine LB, et al. Prognostic factors of recurrence after vesicovaginal fistula repair. Int J Urol. 2006;13:345.
Gil-Vernet JM, Gil-Vernet A, Campos JA. New surgical approach for treatment of complex vesicovaginal fistula. J Urol. 1989;141:513.
Mohseni MG, Hosseini SR, Alizadeh F, et al. Bladder mucosal autograft: an effective method for repair of vesicovaginal fistula. Adv Biomed Res. 2019;1:77.
Eisen M, Jurkovic K, Altwein JE, et al. Management of vesicovaginal fistulas with peritoneal flap interposition. J Urol. 1974;112:195.
James MH, Tisdale BE, Davies TO, et al. The urachal flap: a previously unreported tissue flap in vesicovaginal fistula repair. Female Pelvic Med Reconstr Surg. 2013;19:148.
Salup RR, Julian TB, Liang MD, et al. Closure of large postradiation vesicovaginal fistula with rectus abdominis myofascial flap. Urology. 1994;44:130.
Ackerman AL, Blaivas J, Anger JT. Female urethral reconstruction. Curr Bladder Dysfunct Rep. 2010;5:225.
Hilton P. Vesico-vaginal fistula: new perspectives. Curr Opin Obstet Gynecol. 2001;13:513.
Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72:313.
Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. 1980;123:370.
Brandes S, Coburn M, Armenakas N, et al. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int. 2004;94:277.
Allen-Mersh TG, Wilson EJ, Hope-Stone HF, et al. The management of late radiation-induced rectal injury after treatment of carcinoma of the uterus. Surg Gynecol Obstet. 1987;164:521.
Tsang CB, Madoff RD, Wong WD, et al. Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum. 1998;41:1141.
De Ridder D. An update on surgery for vesicovaginal and urethrovaginal fistulae. Curr Opin Urol. 2011;21:297.
Eilber KS, Rosenblum N, Rodriguez LV. Vesicovaginal fistula: complex fistulae. In: Vasavada SP, Appell RA, Sand PK, Raz S, editors. Female urology, urogynecology, and voiding dysfunction. New York: CRC; 2005. p. 761–82.
Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol. 2002;99:229.
Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. N Engl J Med. 1993;328:856.
Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol. 2008;198:34 e1.
Forsgren C, Altman D. Risk of pelvic organ fistula in patients undergoing hysterectomy. Curr Opin Obstet Gynecol. 2010;22:404.
Falcone T, Walters MD. Hysterectomy for benign disease. Obstet Gynecol. 2008;111:753.
Nieboer TE, Johnson N, Lethaby A et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009;CD003677.
Forsgren C, Lundholm C, Johansson AL, et al. Hysterectomy for benign indications and risk of pelvic organ fistula disease. Obstet Gynecol. 2009;114:594.
Duong TH, Gellasch TL, Adam RA. Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy. Am J Obstet Gynecol. 2009;201:512 e1.
Likic IS, Kadija S, Ladjevic NG, et al. Analysis of urologic complications after radical hysterectomy. Am J Obstet Gynecol. 2008;199:644 e1.
Bai SW, Huh EH, Jung da J, et al. Urinary tract injuries during pelvic surgery: incidence rates and predisposing factors. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:360.
Duong TH, Taylor DP, Meeks GR. A multicenter study of vesicovaginal fistula following incidental cystotomy during benign hysterectomies. Int Urogynecol J. 2011;22:975.
Caquant F, Collinet P, Debodinance P, et al. Safety of trans vaginal mesh procedure: retrospective study of 684 patients. J Obstet Gynaecol Res. 2008;34:449.
Starkman JS, Meints L, Scarpero HM, et al. Vesicovaginal fistula following a transobturator midurethral sling procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:113.
Rogo-Gupta L, Rodriguez LV, Litwin MS, et al. Trends in surgical mesh use for pelvic organ prolapse from 2000 to 2010. Obstet Gynecol. 2012;120:1105.
Perez CA, Grigsby PW, Lockett MA, et al. Radiation therapy morbidity in carcinoma of the uterine cervix: dosimetric and clinical correlation. Int J Radiat Oncol Biol Phys. 1999;44:855.
Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. 2001;11:417.
Hilton P. Urogenital fistula in the UK: a personal case series managed over 25 years. BJU Int. 2012;110:102.
Waaldijk K. The immediate management of fresh obstetric fistulas. Am J Obstet Gynecol. 2004;191:795.
Bazi T. Spontaneous closure of vesicovaginal fistulas after bladder drainage alone: review of the evidence. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:329.
Stovsky MD, Ignatoff JM, Blum MD, et al. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol. 1994;152:1443.
Shekarriz B, Stoller ML. The use of fibrin sealant in urology. J Urol. 2002;167:1218.
Shaker H, Saafan A, Yassin M, et al. Obstetric vesico-vaginal fistula repair: should we trim the fistula edges? A randomized prospective study. Neurourol Urodyn. 2011;30:302.
Karram MM. In: Walters MD, Karram MM, editors. Urogynecology and reconstructive pelvic surgery. 3rd ed. Philadelphia, PA: Mosby Elsevier; 2007. p. 445–71.
Nezhat CH, Nezhat F, Nezhat C, et al. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. 1994;83:899.
Melamud O, Turbow B, Shanberg AM. Robot-assisted laparoscopic vesicovaginal fistula repair. J Urol. 2005;173:134.
Sotelo R, Moros V, Clavijo R, et al. Robotic repair of vesicovaginal fistula (VVF). BJU Int. 2012;109:1416.
Shah SJ. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2009;23:1135.
Leach GE. Urethrovaginal fistula repair with Martius labial fat pad graft. Urol Clin North Am. 1991;18:409.
Gebhart JB, Lee RA. Urethrovaginal fistula. In: Valsavada SP, Appell RA, Sand PK, Raz S, editors. Female urology, urogynecology, and voiding dysfunction. New York: Marcel Dekker; 2005. p. 797–810.
Pushkar DY, Dyakov VV, Kosko JW, et al. Management of urethrovaginal fistulas. Eur Urol. 2006;50:1000.
Siegel AL. Urethral necrosis and proximal urethro-vaginal fistula resulting from tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:661.
Reisenauer C, Wallwiener D, Stenzl A, et al. Urethrovaginal fistula–a rare complication after the placement of a suburethral sling (IVS). Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:343.
Flisser AJ, Blaivas JG. Outcome of urethral reconstructive surgery in a series of 74 women. J Urol. 2003;169:2246.
Glavind K, Larsen EH. Results and complications of tension-free vaginal tape (TVT) for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:370.
Carlin BI, Klutke CG. Development of urethrovaginal fistula following periurethral collagen injection. J Urol. 2000;164:124.
Hilton P. Urethrovaginal fistula associated with ‘sterile abscess’ formation following periurethral injection of dextranomer/hyaluronic acid co-polymer (Zuidex) for the treatment of stress urinary incontinence–a case report. BJOG. 2009;116:1527.
Zimmern PE, Hadley HR, Leach GE, et al. Transvaginal closure of the bladder neck and placement of a suprapubic catheter for destroyed urethra after long-term indwelling catheterization. J Urol. 1985;134:554.
McGuire EJ, Savastano J. Comparative urological outcome in women with spinal cord injury. J Urol. 1986;135:730.
Ahmad S, Nishtar A, Hafeez GA, et al. Management of vesico-vaginal fistulas in women. Int J Gynaecol Obstet. 2005;88:71.
Senatore Jr PJ. Anovaginal fistulae. Surg Clin North Am. 1994;74:1361.
Venkatesh KS, Ramanujam PS, Larson DM, et al. Anorectal complications of vaginal delivery. Dis Colon Rectum. 1989;32:1039.
Angioli R, Gomez-Marin O, Cantuaria G, et al. Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol. 2000;182:1083.
Choi JM, Nguyen V, Khavari R, et al. Complex rectovaginal fistulas after pelvic organ prolapse repair with synthetic mesh: a multidisciplinary approach to evaluation and management. Female Pelvic Med Reconstr Surg. 2012;18:366.
Yong PJ, Garrey MM, Geoffrion R. Transvaginal repair and graft interposition for rectovaginal fistula due to a neglected pessary: case report and review of the literature. Female Pelvic Med Reconstr Surg. 2011;17:195.
Champagne BJ, McGee MF. Rectovaginal fistula. Surg Clin North Am. 2010;90:69.
Ellis CN. Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum. 2008;51:1084.
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Jellison, F.C., Raz, S. (2015). Vaginal Fistula Repairs. In: Firoozi, F. (eds) Female Pelvic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1504-0_10
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