[Transvaginal closure of vesicovaginal fistulas]

The surgical management of vesicovaginal fistulae (VVF) is a matter of controversy. This study deals with our experience with transvaginally treated patients suffering from VVF. Between 1966 and 1996, 64 patients with VVF were treated surgically. The VVF occurred in the course of hysterectomy in 54 patients, was due to radiotherapy in 7, was a result of obstetric complications in 2 patients, and occurred after colporrhaphy in 1 patient. In 60 of these 64 patients closure of the fistula was carried out transvaginally. Fourteen of these 60 patients (23%) had undergone prior surgical attempts to close the VVF (1 to 3 procedures). Transvaginal surgery was successful at first attempt in 55 of these 60 patients (92%). The other 5 patients were successfully treated by a second procedure (again transvaginal: n = 3; transabdominal: n = 2). In conclusion, the transvaginal approach to close VVF is of advantage, avoiding an abdominal incision and reducing postoperative morbidity. In the vast majority of the cases isolated VVF can be treated successfully by transvaginal repair.