Urinary fistulas: What does the evidence say?

Abstract

Urinary fistulas are well-recognized, iatrogenic complications in developed countries that require timely diagnosis and tailored management. Vesicovaginal fistula (VVF) is the most common type of urinary fistula. Depending on the size, mechanism of injury, time of discovery, evidence of active inflammation, and experience of the surgeon, a wide range of treatment options exist for VVF. Most fistulas can be promptly repaired transvaginally, with high success rates at the time of diagnosis unless there are ongoing inflammatory processes. Tissue interposition and surgical approach should be guided by individual case. The role of novel techniques for urinary fistula repair—such as laparoscopic-assisted approach, endoscopic fulguration, and use of fibrin glue—is still being defined and currently has limited application. This article reviews the current literature and establishes guidelines for the evaluation and management of VVF.