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Current techniques for vesicovaginal fistula repair: Surgical pearls to optimize cure rate

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Abstract

Vesicovaginal fistulas (VVFs) are a devastating consequence of prolonged labor in developing countries and pelvic surgery in developed countries. Clinical history, physical examination, and pertinent radiographic studies are necessary for proper diagnosis. Endoscopic management can lead to successful closure of small fistulas; the advent of tissue bioglues has made this modality more promising. However, the majority of patients will require transvaginal or transabdominal repair of the fistula. This article reviews the basic principles of fistula closure and discusses adjuvant techniques with tissue interposition grafts; techniques for successful closure of fistulas; and newer modalities for repair using tissue bioglues, laparoscopy, and robotic surgery.

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References and Recommended Reading

  1. Roenneburg ML, Genadry R, Wheeless Jr CR: Repair of vesicovaginal fistulas in Africa. Am J Obst Gyn 2006, 195:1748–1752.

    Article  Google Scholar 

  2. Second Meeting of the Working Group for the Prevention and Treatment of Obstetrical Fistula, Addis Ababa, Africa; October 30, 2002. New York: United Nations Population Fund; 2003.

  3. Evans DH, Madjar S, Politano VA, et al.: Interposition flaps in transabdominal fistula repairs: are they really necessary? Urology 2001, 57(4):670–674.

    Article  PubMed  CAS  Google Scholar 

  4. Eilber KS, Kavaler E, Rodriguez LV, et al.: Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol 2003, 169:1033–1036.

    Article  PubMed  Google Scholar 

  5. Rovner ES: Vesicovaginal and urethrovaginal fistulas. AUA Update Series 2006, 25:45–56.

    Google Scholar 

  6. Huang WC, Zinman LN, Bihrle W: Surgical repair of vesicovaginal fistulas. Urol Clin NA 2002, 29:709–723.

    Article  Google Scholar 

  7. Boronow RC: Repair of the radiation-induced vaginal fistula utilizing the Martius technique. World J Surg 1986, 10:237–248.

    Article  PubMed  CAS  Google Scholar 

  8. Blandy JP, Badenoch DF, Fowler CG, et al.: Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol 1991, 146:761–765.

    PubMed  CAS  Google Scholar 

  9. Goodwin WE, Scardino PT: Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol 1980, 123:370–374.

    PubMed  CAS  Google Scholar 

  10. Blaivas JG, Heritz DM, Romanzi LJ: Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol 1995, 153:1110–1112.

    Article  PubMed  CAS  Google Scholar 

  11. O’Conor VJ: Review of experience with vesicovaginal fistula repair. J Urol 1980, 123:367–369.

    PubMed  Google Scholar 

  12. Wein AJ, Mallory TR, Carpiniello VL, et al.: Repair of vesico-vaginal fistula by a suprapubic transvesical approach. Surg Gynecol Obstet 1980, 150:57–60.

    PubMed  CAS  Google Scholar 

  13. Raz S, Bregg KJ, Nitti VW, Sussman E: Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol 1993, 150;56–59.

    Google Scholar 

  14. O’Conor VJ: Transperitoneal transvesical repair of vesicovaginal fistula with omental interposition. AUA Update Series 1991, 10:lesson 13.

    Google Scholar 

  15. Persky L, Herman G, Guerrier K: Nondelay in vesicovaginal fistula repair. Urology 1979, 13:273–275.

    Article  PubMed  CAS  Google Scholar 

  16. Cruikshank SH: Early closure of posthysterectomy vesicovaginal fistulas. South Med J 1988, 81:1525–1528.

    PubMed  CAS  Google Scholar 

  17. Melah GS, El-Nafaty AU, Bukar M: Early versus late closure of vesicovaginal fistulas. Int J Gynecol Obstet 2006, 93:252–253.

    Article  CAS  Google Scholar 

  18. Chapple C, Warwick RT: Surgical atlas vesico-vaginal fistula. BJU Int 2005, 95:193–214.

    Article  PubMed  Google Scholar 

  19. Stovsky MD, Ignatoff JM, Blum MD, et al.: Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol 1994, 152:1443–1444.

    PubMed  CAS  Google Scholar 

  20. Muto G, D’Urso L, Castelli E, et al.: Cyanoacrylic glue: a minimally invasive nonsurgical first line approach for the treatment of some urinary fistulas. J Urol 2005, 174:2239–2243.

    Article  PubMed  CAS  Google Scholar 

  21. Sharma SK, Perry KT, Turk TMT: Endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. J Endourol 2005, 19:419–423.

    Article  PubMed  Google Scholar 

  22. Spotnitz WD, Falstrom JK, Rodeheaver GT: The role of sutures and fibrin sealant in wound healing. Surg Clin NA 1997, 77:651–669.

    Article  CAS  Google Scholar 

  23. Bold EL, Wanamaker JR, Zins JE, et al.: The use of fibrin glue in the healing of skin flaps. Am J Otolaryngol 1996, 17:27–30.

    Article  PubMed  CAS  Google Scholar 

  24. Evans LA, Morey AF: Hemaostatic agents and tissue glues in urologic injuries and wound healing. Urol Clin NA 2006, 33:1–12.

    Article  Google Scholar 

  25. Langkilde NC, Pless TK, Lundbeck F, Nerstrom B: Surgical repair of vesicovaginal fistulae: a ten-year retrospective study. Scand J Urol Nephrol 1999, 33:100–103.

    Article  PubMed  CAS  Google Scholar 

  26. Frohmuller H, Hofmockel G: Transvaginal closure of vesicovaginal fistulas. Urologe A 1998, 37:70–74.

    Article  PubMed  CAS  Google Scholar 

  27. Wang Y, Hadley HR: Nondelayed transvaginal repair of high lying vesicovaginal fistula. J Urol 1990, 144:34–36.

    PubMed  CAS  Google Scholar 

  28. Iselin CE, Aslan P, Webster GD: Transvaginal repair of vesicovaginal fistulas after hysterectomy by vaginal cuff excision. J Urol 1998, 160:728–730.

    Article  PubMed  CAS  Google Scholar 

  29. Margolis T, Mercer LJ: Vesicovaginal fistula. Obstet Gynecol Surv 1994, 49:840–847.

    Article  PubMed  CAS  Google Scholar 

  30. Elkins TE, DeLancey JO, McGuire EJ: The use of modified Martius graft as an adjunctive technique in vesicovaginal and rectovaginal fistula repair. Obstet Gynecol 1990, 75:727–733.

    PubMed  CAS  Google Scholar 

  31. Nesrallah LJ, Srougi M, Gittes RF: The O’Conor technique: the gold standard for supratrigonal vesicovaginal fistula repair. J Urol 1999, 161:566–568.

    Article  PubMed  CAS  Google Scholar 

  32. O’Conor VJ: Review of experience with vesicovaginal fistula repair. J Urol 1980, 123:367–369.

    PubMed  Google Scholar 

  33. Gil-Vernet JM, Gil-Vernet A, Campos JA: New surgical approach for treatment of complex vesicovaginal fistula. J Urol 1989, 141:513–516.

    PubMed  CAS  Google Scholar 

  34. Motiwala HG, Amlani JC, Desai KD, et al.: Transvesical vesicovaginal fistula repair: a revival. Eur Urol 1991, 19:24–28.

    PubMed  CAS  Google Scholar 

  35. Kristensen JK, Lose G: Vesicovaginal fistulas: the transperitoneal repair revisited. Scand J Urol Nephrol 1994, 157(Suppl):101–105.

    CAS  Google Scholar 

  36. Dalela D, Ranjan P, Sankhwar PL, et al.: Supratrigonal VVF repair by modified O’Conor technique: an experience of 26 cases. Eur Urol 2006, 49:551–556.

    Article  PubMed  Google Scholar 

  37. Ayed M, El Atat R, Ben Hassine L, et al.: Prognostic factors of recurrence after vesicovaginal fistula repair. Int J Urol 2006, 13:345–349.

    Article  PubMed  Google Scholar 

  38. Eisen M, Jurkovic K, Altwein JE, et al.: Management of vesicovaginal fistulas with peritoneal flap interposition. J Urol 1974, 112:195–198.

    PubMed  CAS  Google Scholar 

  39. Lytton B: Vesicovaginal fistula: postsurgical. In Current Therapy in Genitourinary Surgery. Philadelphia: BC Decker; 1992:261–265.

    Google Scholar 

  40. Salup RR, Julian TB, Liang MD, et al.: Closure of large postradiation vesicovaginal fistula with rectus abdominis myofascial flap. Urology 1994, 44:130–131.

    Article  PubMed  CAS  Google Scholar 

  41. Sotelo R, Mariano MB, Garcia-Segui A, et al.: Laparoscopic repair of vesicovaginal fistula. J Urol 2005, 173:1615–1618.

    Article  PubMed  Google Scholar 

  42. Chibber PJ, Shah HN, Jain P: Laparoscopic O’Conor’s repair for vesico-vaginal and vesico-uterine fistulae. BJU Int 2005, 96:183–186.

    Article  PubMed  Google Scholar 

  43. Wong C, Lam PN, Lucente VR: Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol 2006, 20:240–243.

    Article  PubMed  Google Scholar 

  44. Sundaram BM, Kalidasan G, Hemal AK: Robotic repair of vesicovaginal fistula: case series of five patients. Urology 2006, 67:970–973.

    Article  PubMed  Google Scholar 

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Correspondence to Angelo E. Gousse.

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Cohen, B.L., Gousse, A.E. Current techniques for vesicovaginal fistula repair: Surgical pearls to optimize cure rate. Curr Urol Rep 8, 413–418 (2007). https://doi.org/10.1007/s11934-007-0040-6

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