Treatment of Vesicovaginal Fistula That Is High, Complex, or Involves the Trigone Area
Not all vesicovaginal fistulas can be managed through the same surgical route. A subset of VVF cases presents with anatomical or technical features that determine the appropriate repair strategy.
Clinical Scenario
This protocol applies when the VVF is high or complex, involves the trigone area, requires ureteral reimplantation, is associated with a low bladder capacity that requires bladder augmentation, or is difficult to approach through the vagina.
Surgical Approach — Overview
A transabdominal surgical approach is recommended for these cases, with the operative technique — transvesical or extravesical — and the use of adjunctive procedures selected according to the individual patient's presentation.
Full technique selection criteria, procedural details, and specific indications are in the complete protocol.
References
- This approach is recommended if the VVF is high or complex, involves the trigone area, requires ureteral reimplantation, is associated with a low bladder capacity that requires bladder augmentation, or is difficult to approach through the vagina.
- The transabdominal approach may be performed using either a transvesical or extravesical technique.
- The traditionally performed technique is the transvesical bivalve bladder technique (O'Conor technique).
- Although omental flap interposition is not routinely performed, it should be performed in patients with recurrent VVFs, large fistulas, irradiated tissue, or obstetric fistulas.
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