Repair of vesicovaginal fistulas: simultaneous transvaginal-transvesical approach

The records of 91 patients with vesicovaginal fistulas at the Ochsner Clinic between 1942 and 1974 were reviewed. The fistulas were managed in several ways: spontaneous closure, palliative operation, urinary diversion, transvesical repair, transvaginal repair, and a combined transvaginal-transvesical procedure. The latter had a 100% success rate in the eight patients in whom it was used. The technic of this procedure is described and the indications are expanded to include (1) large fistulas, (2) fistulas near the ureteral orifice, (3) if other abdominal or urologic surgery is being done, (4) if transvesical approach is being used, (5) previous failed attempts at correction, (6) difficulty of access by vaginal approach, and (7) fistulas resulting from transurethral resection of the bladder neck.