[Surgical repair of vesico-vaginal fistulae with abdominal-transvesical approach. Comments on this technique and long-term results].

OBJECTIVES: We reviewed our series of vesicovaginal fistula that had been treated by the abdominal-transvesical approach, which we have also utilized in complex relapsed fistulas of the posterior aspect of the bladder in all but one case of triple fistula associated with lithiasis of the bladder. METHODS: 6 patients with vesicovaginal fistula secondary to pelviogynecological surgery were treated by the abdominal-transvesical approach. One patient had been referred to our hospital for a triple fistula that had relapsed for the fifth time. This patient was submitted to cystolithotomy during the same session. Another patient with urinary incontinence and cystocele prior to the fistula underwent unrethrocervicopexy following the Marshall-Marchetti-Krantz technique after fistula repair. All the cases were treated by the same surgeon without omental interposition. RESULTS: Excellent results were achieved in all 6 cases, with no fistula relapse. The urinary infection disappeared in those patients with this complication prior to fistula repair. Patient control evaluation was performed 6-12 months postoperatively and at 4 years. All 6 patients are currently urologically asymptomatic and continent. CONCLUSIONS: In our view, vesicovaginal fistula repair can be done via the vaginal, abdominal or combined approach. We do not believe that one technique is superior over the other. Although the 6 cases described herein are not significant statistically, the abdominal-transvecial approach has been successful in these 6 cases, despite the difficulty that is always encountered in some cases of vesicovaginal fistula, regardless of the technique utilized. Omental interposition may be useful in those cases with a large fistulous defect. Some advocate fistulectomy in all cases. The time to surgical correction following diagnosis was always more than three months. The crossed or x-shaped suture achieves minimal superpositioning. Postoperative bladder drainage should not lie on the suture of the bladder mucosa to prevent decubitus through placement of a cystostomy tube. The foregoing points are essential in this procedure.