Urethrovaginal Fistula Repair

Abstract

Urethrovaginal fistulas are abnormal communications between the female urethra and vagina. For the reconstructive surgeon, there are many challenging aspects to the diagnosis and management of urethrovaginal fistulas. This is due in large part to the unique and complex anatomy often present, the surgical expertise required in the operating room, and the risk of postoperative morbidity or recurrence. Fortunately, urethrovaginal fistulas are rare in practice and most commonly the result of iatrogenic injuries in the developed world. In contrast, most urethrovaginal fistulas result from obstructed labor in the developing world. Surgical repair is the mainstay of definitive treatment for urethrovaginal fistulas. General principles of other urogenital fistula repair also apply to urethrovaginal fistulas including identification of adequately vascularized tissue, tension-free suture lines, and initial diversion of urine. Compared to those of vesicovaginal fistulas, options for urethrovaginal fistula repair may be more limited given the urethra’s tenuous blood supply, limited mobility, and delicate interposing tissue planes. Techniques of repair vary depending on the complexity of the fistula and are usually performed with primary excision and closure of a vaginal flap. Interpositional flaps and grafts are reserved for more advanced disease. Postoperative complications include stress urinary incontinence (SUI), obstructed voiding secondary to stricture, and fistula recurrence.