Management of female genitourinary fistulas: transvesical or transvaginal approach?

Abstract

We reviewed 25 female genitourinary fistula repairs performed at our institution from 1993 to 1997. Our series comprised 7 primary vesicovaginal, 6 recurrent vesicovaginal, 7 complex, 1 ureterovaginal and 4 urethrovaginal fistulas. Postoperative followup ranged from 8 months to 5 years. Overall, 92% of the patients were cured (23 of 25). The 2 failures occurred in patients with a history of pelvic malignancy involving adjuvant therapy. Complex irradiated vesicovaginal fistulas require staged repairs, often with pedicle flaps. However, primary repair of uncomplicated vesicovaginal fistulas is highly successful. Limited transvesical repair of these fistulas offers reliable success with minimal morbidity and hospital stay comparable to those of the transvaginal approach.