Treatment of vesicovaginal fistulas: an experience of 30 cases.

BACKGROUND Vesicovaginal fistulas (VVF) are rare. In developed countries, the majority of vesicovaginal fistulas occur after gynecological procedures such as total hysterectomies. OBJECTIVE The evaluation of successfulness of VVF surgical repairs with transvesical, transvaginal and transabdominal approach with omental flap in 30 patients. METHODS This is a retrospective study of patients suffering from VVF who were treated with transvesical, transvaginal and transabdominal approach with omental flap from July 2004 until December 2012. During that period, 30 patients with VVF underwent a surgical treatment at the Clinic of Urology, University Clinical Center of Banjaluka. Ten patients had previously taken radiotherapy due to cervical cancer and as a consequence of that VVF developed. In 19 patients, fistula occurred after total hysterectomy, and in one patient it occurred after the cesarean section. In six patients, primary surgical repair was performed by supravesical urinary diversion. The average size of fistula was 14 mm. RESULTS The primary repair of VVF was successful in 75.00% of patients (18/24). In six patients (25.00%), it was not successful, and they remained incontinent. The successfulness of primary repairs with transvaginal and transabdominal approach with the use of omental flap was 100%, and with transvesical approach, it was 68.42%. The secondary surgical repair was performed in the remaining five patients, and it was successful in two patients (40.00%), but cumulatively speaking, the successfulness was 83.33% (20/24). In the secondary repair, the successfulness of transvaginal approach was 50.00%, and of transvesical one, it was 33.33%. Three patients underwent the tertiary surgical repair and its successfulness was 0%, and the approaches were transvaginal in one patient, transvesical in another one, and combination of transvesical with additional stitches with transvaginal approach in the third patient. When the surgical repair was undertaken for the fourth time, the successfulness was 100%. In two patients, the approach was transabdominal with interposition of omental flap, and in one patient, the approach was transvaginal. When everything is taken into consideration, 23 out of 24 patients had a successful closure of fistula, and we lost track of one patient whose primary repair was unsuccessful. CONCLUSION The selective approach to the repair of VVF mostly depends on the surgeons skill and experience. The successfulness of the repair depends on the excision of the pathological tissue, the closure of fistula in a well vascularized tissue and on urine drainage.