Surgical Treatment of Vesicovaginal Fistula: Transvaginal Repair
Clinical Scenario
Vesicovaginal fistula (VVF) is an abnormal communication between the bladder and vagina, resulting in continuous urinary leakage. Surgical closure is the definitive treatment, and the approach and technique are selected based on fistula characteristics and available expertise.
Treatment Overview
The standard approach involves surgical repair via the transvaginal route. A widely used technique involves careful dissection around the fistulous tract, followed by multi-layer closure with absorbable sutures. In selected cases, tissue interposition using vascularised flaps may be incorporated to improve outcomes.
The complete repair algorithm, tissue interposition options, and procedural details are available in the full protocol.
References
- Most successful surgical repairs of VVFs involve the transvaginal approach.
- The most common surgical technique is Latzko's colpocleisis, which is easily performed by dissecting the fistulous tract and surrounding tissue by about 2 to 3 cm.
- The defect is then closed with multiple layers of absorbable sutures.
- Tissue interposition using a peritoneal, gracilis muscle, omental, peritoneal, Martius labial fat flap, or a bladder mucosa autograft can be performed to increase the vascular supply and thus increase the success rate.
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