The O'Conor technique: the gold standard for supratrigonal vesicovaginal fistula repair

Several techniques have been used for repair of vesicovaginal fistula. Although surgical success is achieved in the majority of cases, a 4 to 35% failure rate occurs when a transvesical or transvaginal approach is used. We investigated the clinical efficacy of the O'Conor transperitoneal supravesical technique for supratrigonal vesicovaginal fistula.

A total of 29 patients with iatrogenic supratrigonal vesicovaginal fistula following hysterectomy or cesarean section were studied. An initial operation and prior attempts at fistula repair had been performed in 9 patients (34%) for benign (26) or malignant (3) uterine conditions. All patients were treated with the O'Conor technique 6 weeks to 48 months (median 8 weeks) after fistula diagnosis.

The vesicovaginal fistula was successfully corrected in all patients at the first attempt and only 1 had stress urinary incontinence associated with urethral incompetence. No significant bladder dysfunction or decrease in bladder capacity was seen after repair.

Considering the inferior clinical results of the transvaginal and transvesical approaches compared to the O'Conor technique for repair of supratrigonal vesicovaginal fistula, it would be unethical to conduct a randomized study to prove the superiority of the latter method. We suggest that the O'Conor technique be considered the gold standard surgical method of repair of supratrigonal vesicovaginal fistulas.