Management of vesicovaginal fistulas after gynecologic surgery

OBJECTIVE: In developed nations, surgery, especially gynecologic procedures, is the major cause of vesicovaginal fistulas (VVFs). We retrospectively evaluated our treatment modalities for VVF repair caused by a gynecologic surgery, and discussed the reasons of selecting certain surgical techniques and their outcomes. MATERIALS AND METHODS: We compared the surgical procedure preferences of surgeons and their results with patient and surgeon characteristics for the management of VVFs after an inciting gynecologic surgery in Suleyman Demirel University Hospital, Isparta over a 10-year period. The surgical procedures were undertaken in departments of urology and obstetrics and gynecology. RESULTS: Abdominal repair was chosen for 65%, vaginal repair for 25%, and laparoscopic repair for 10% of patients. For the 75% of the patients that urologists operated, they chose the abdominal route. The mean parity number of patients who underwent abdominal repair was lower than that for vaginal repairs (p<0.05). For the patients managed with the vaginal route, 20% had a Martius flap, and 80% had a simple excision and repair. For patients operated via the abdominal route, 18% needed omental flap; no tissue interposition was used for the rest. The mean hospitalization time was less in patients managed with transvaginal repair (3.4 days) compared with transabdominal repair (9.2 days) (p<0.05). CONCLUSION: The choice of repair method depends on surgeon's training (gynecology vs. urology). The vaginal route should be the first choice because it does not compromise the success rate and the mean hospitalization time is less. For the transvaginal approach, access to the lesion is the most important factor for the success of the procedure. No flap is needed for tissues that appear well vascularized.