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Vesicovaginal fistula.

H Roger Hadley¹

¹Division of Urology, Loma Linda University, 11234 Anderson Street, Room A560, Loma Linda, CA 92354, USA. rhadley@ahs.llumc.edu

Current Urology Reports

|October 2, 2002

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Vesicovaginal fistulas (VVFs) are often caused by hysterectomy complications in North America and childbirth in underdeveloped countries. Early transvaginal repair offers a less invasive, highly successful treatment option for most patients.

Area of Science:

Urology
Gynecology
Surgical Innovation

Background:

Vesicovaginal fistula (VVF) is an abnormal connection between the bladder and vagina.
Etiologies vary globally, with surgical injury (hysterectomy) common in North America and childbirth complications prevalent in underdeveloped regions.
Diagnosis is typically straightforward, but vigilance is required to detect multiple fistulas or ureteral injuries.

Purpose of the Study:

To outline the diagnostic considerations and management strategies for vesicovaginal fistulas.
To discuss the factors influencing the timing and approach for VVF repair.
To highlight the efficacy of the transvaginal approach for VVF treatment.

Main Methods:

Review of current literature and clinical guidelines on VVF diagnosis and management.

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Analysis of etiological factors, diagnostic challenges, and surgical repair techniques.

Evaluation of the success rates and indications for different surgical approaches.

Main Results:

Hysterectomy and childbirth are primary causes of VVF.
Early diagnosis is crucial, with potential for coexisting injuries.
The transvaginal approach demonstrates high success rates (≥90%), is less invasive, and allows for earlier repair.
Complex cases (post-irradiation, recurrent) may necessitate vascularized tissue interposition.

Conclusions:

VVF diagnosis requires careful assessment to identify all injuries.
Repair timing and technique should be individualized based on fistula etiology and patient factors.
The transvaginal approach is a preferred method for early and successful VVF repair.
Challenging fistulas may require advanced surgical techniques.