[Intestinal plastic repair in vesicovaginal fistula]

The author reports a case of a good outcome of vesicovaginal fistula surgery. The fistula emerged in a 37-year-old woman who had previously undergone the cesarean section followed by supravaginal amputation of the uterus complicated by bladder injury. Long-term conservative treatment of the vesicovaginal fistula was a failure. The patient complained of incontinence of urine and its evacuation via the vagina. Cystoscopically, the fistula had a funnel shape and was located posteriorly on the fundus of the bladder which demonstrated mucosal scars and inflammation-trophic lesions. Upon transvesical fistuloplasty via the transperitoneal approach the surgeons found 2 fistulas connecting the bladder with the vagina. The bladder walls underwent sclerotic changes. Ureteral catheterization failed. On postoperative day 2 the symptoms of renal insufficiency were observed due to surgical injury of the ureters. The critical condition of the patient urged one-stage restorative surgery which was performed with sigmoidocystoplasty. Both ureters were transplanted into intestinal graft. No postoperative complications developed. The patient was followed up for 3 years. She retains the urine completely, the urination occurs in 3-4 hours, 1-2 times at night. The kidneys function normally. She resumed her work as a teacher, has a family, avoided invalidity. This case says in favour of an individual approach to surgical policy which ensures optimal scope of operative treatment promising beneficial outcome.