Abstract
Objective
To present the major causes, diagnosis, indications, and basic principles of surgical treatment of vesico-vaginal fistulas (VVF).
Methods
From 1978 to 2004, 235 surgical procedures in 220 women with vesico-vaginal fistulas were performed at the Clinical Center of Serbia, Urological Clinic, due to primary or recurrent VVF. There were 220 primary procedures: 129 transvesical approaches (TVES), 59 transvaginal repairs (TVAG), and 32 transperitoneal approaches with flap interposition (TPA). Transvesical approach was the most common procedure in the early period (1978–1993) and less frequent in the late period (1994–2004). The main causes of VVF were hysterectomy for benign conditions (62.7%), hysterectomy for malignant conditions (30.4%), cesarean section (5.9%), and obstetric injuries (0.9%).
Results
There was no perioperative mortality. There were fifteen recurrent fistula formations: twelve after the first operation and three after the second. The recurrence rates between the procedures were comparable: TVES 6.6%, TVAG 6.4%, and TPA 5.4%.
Conclusions
The total recurrence rate of 6.4% did not differ significantly between various procedures. However, TVAG is less invasive and suitable for uncomplicated cases, whereas TPA should be recommended for great and recurrent VVF.
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Hadzi-Djokic, J., Pejcic, T.P. & Acimovic, M. Vesico-vaginal fistula: report of 220 cases. Int Urol Nephrol 41, 299–302 (2009). https://doi.org/10.1007/s11255-008-9449-1
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DOI: https://doi.org/10.1007/s11255-008-9449-1