Experience of our surgery in iatrogenic vesicovaginal fistulas

Abstract

In this study, transvesical and transvaginal approaches used in our clinic for the treatment of gynecologic iatrogenic vesicovaginal fistulas are discussed. 11 patients with vesicovaginal fistula admitted to the Department of Urogynecology, Zeynep Kamil Teaching- Research Hospital between 2005-2009 were enrolled in our study. Transvesical and transvaginal fistula repair were performed on all patients. All patients were treated by surgical repair, 4 cases by a classic transabdominal approach, 5 cases by an omental flap interposition and 2 cases by a martius flap interposition. The most common cause of iatrogenic vesicovaginal fistula in our patients was total abdominal hysterectomy for benign conditions (n=10/11). The mean patient age was 43 years (34-53) and the mean time from the causative surgery to the operation was 7.5 months (3-12). The surgical techniques were successful in all patients. There were no intraoperative complications and no postoperative recurrences. The mouth of the fistula should be determined clearly on preoperative evaluation and surgery procedure should be planned according to the fistula aperture. The point to be careful of is excision of all diseased tissue in the bladder and vagina, complete separation of the bladder from the vagina with a margin of healthy tissue, and watertight closure of both bladder and vagina without tension. The aim of the vascularized tissue interposition between the closed bladder and the vagina is to provide the improvement of vascularity. We believe that in the treatment of supratrigonal and large fistulas, the transvesical approach with use of omental flap interposition is more effective, while, in the treatment of small and trigonal fistula, the transvaginal approach with use of martius flap interposition is an effective tecnique.