Management of urethrovaginal fistulae

Urethrovaginal fistulae are a rare condition. It is a conceptual mistake to consider urethrovaginal fistulae to be synonymous with vesicovaginal fistulae. Urethrovaginal fistulae are a different entity requiring special attention and treatment. Due to the wide variety and individuality of the clinical manifestations of these injuries, it is practically impossible to find and create common guidelines for treatment. Taking into account the difficulty of urethrovaginal fistula treatment, we decided to conduct a review of the current literature on this subject.

Due to advances in obstetric care, urologists in the developed world encounter urethrovaginal fistulae rarely, and many of the fistulae seen are secondary to vaginal surgery. Surgical treatment procedures include direct primary anatomical repair and interpositional tissue restorations, mainly by Martius flap. Successful direct anatomical repair alone may result in the development of stress urinary incontinence or obstructed voiding in up to 50% of patients. Synthetic tape should be removed during fistula repair, which may lead to the resumption of stress incontinence.

Prevention of urethrovaginal fistulae can be achieved through both improvements in obstetric care and adequate training in vaginal surgery. The success of any surgical treatment depends on careful patient selection, and assumes knowledge of all possible treatment options. Potential work needs to be directed towards the application of the newest molecular technologies.