Two-stage repair of giant vesico-vaginal fistula

A review of 840 bladder fistulae over 10 years revealed that 64 (7.6%) were giant vesico-vaginal fistulae. Association with vaginal stenosis and recto-vaginal fistulae were 23.4% and 4.6%, respectively. The results of direct one-stage repair were poor at 35% for the first attempt while the two-stage repair achieved 80% success at the first attempt. Advantages of the two-stage repair include change in the direction of repair for maximum protection of the terminal ureters and also the possibility of change in patient positioning and approach to the repair of the fistula after the first stage.