Do unplanned cystotomies during vaginal operative procedures lead to vesicovaginal fistulae or other complications?

Abstract

Urology has recently experienced a renewed interest in vaginal operative procedures such as bladderneck suspension, vesicovaginal fistula closure, fascial slings and artificial urinary sphincters. Because many vaginal operations are done on patients who have had previous bladder neck or urethral surgeries, considerable scar tissue may be encountered. With the absence of normal tissue planes unplanned cystotomy may occur. These patients seem likely to develop vesicovaginal fistula due to the dependent vesicotomy. The authors studied a group of 12 patients who had had unplanned cystotomies while undergoing a vaginal procedure. In 11 cases the cystotomy was repaired transvaginally using two layers of 4/0 polyglycolic acid suture, and the originally planned operation was carried out. All patients had a negative cystogram 10 days postoperatively. No patient developed a vesicovaginal fistula or a perivesical infection, even if an artificial urinary sphincter or silastic pledgets were placed. Unplanned cystotomy at the time of vaginal operation should be closed and the scheduled procedure completed. A simple two-layer watertight closure and adequate urethral drainage for at least 1 week is unlikely to develop into a perivesical infection or a vesicovaginal fistula.