Treatment of Vesicovaginal Fistula with Multiple Fistulae, Ureteric Proximity, or Concurrent Pelvic Pathology
Not all vesicovaginal fistulae are anatomically equivalent. When specific features are present — such as multiple fistulae, close proximity to ureteric orifices, limited surgical access, or co-existing abdominal pathology — the clinical approach differs substantially from routine single-fistula repair.
Clinical Scenario
This protocol applies to patients presenting with more than one vesicovaginal fistula, or where ureteric orifices lie within 5 mm of the fistula, or where vaginal exposure is poor, or where concurrent pelvic or abdominal pathology requires intervention during the same operation.
Surgical Approach
For this complex presentation, the evidence-based protocol directs repair via the abdominal route. The specific technique, closure method, and operative sequence are detailed in the full structured regimen.
Treatment Goal
Successful fistula closure, confirmed by absence of the fistula tract, assessed at three weeks following repair.
References
DOI: 10.1097/AOG.0000000000005468Complex fistulae (>1 fistulae, ureteric orifices within 5mm of fistulae, poor vaginal exposure, concurrent pelvic and abdominal pathology requiring intervention during the same operation) were assigned the abdominal route.
The modified repair differed by adding another, fourth layer before closing the vaginal epithelium.
The modified 4-layer closure seems to have a higher success rate for complex fistulae.
Assessment at three weeks showed higher success among the modified repair group at 96.4% versus conventional repair group at 71.4% (p<0.05).
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