ABSTRACT

Objective:

Obstetric trauma, gynecologic or other pelvic surgical interventions were take place in the etiology of vesicovaginal fistulas. In this study, we discussed our approach in the treatment of iatrogenic vesicovaginal fistulas and factors predicting to the result.

Patients and Method:

From 2004 to 2008, the results of 18 patients who referred our hospital with primer vesicovaginal fistulas were retrospectively analyzed according to transvesical/ vaginal surgical approach, early /delayed intervention, fistul tract diameter and place of fistula.

Results:

The median age was 41.94±11 (26–66) years. The causes of the fistulas in our study in a decreasing order were post transabdominal hysterectomy that comprised 18 cases (50%), caesaren section in 5 cases (27.7%) and obstetric injury in the rest 4 cases (22.2%). The mean time from the causative surgery to the operation was 3 (range 2–5) months. All patients (18) were treated with surgical repair as transvaginal approach in 8 and transvesical repair in 10. Place of fistula and diameter were the factors for the determination of surgical approach. The mean follow-up period was 12 (6-20) months. Total successful repair rate was 89%. Failure of repair were in 2 cases, more likely in larger fistulae (> 3 cm) requiring an subsequent abdominal approach (11%).

Conclusion:

In our opinion, the place of fistula and diameter were the main factors for the determination of the surgical approach. Transvesical approach with well vascularised tissue interposition between the vagina and bladder should be preferred for increasing surgical successfull repair rate especially in the large fistula (>3 cm).