The O'Conor technique: The gold standard for supratrigonal vesicovaginal fistula repair

Purpose: Several techniques have been used for repair of vesicovaginal fist ula. Although surgical success is achieved in the majority of cases, a 4 to 35% failure rate occurs when a transvesical or transvaginal approach is us ed. We investigated the clinical efficacy of the O'Conor transperitoneal su pravesical technique for supratrigonal vesicovaginal fistula. Materials and Methods: A total of 29 patients with iatrogenic supratrigonal vesicovaginal fistula following hysterectomy or cesarean section were stud ied. An initial operation and prior attempts at fistula repair had been per formed in 9 patients (34%) for benign (26) or malignant (3) uterine conditi ons. All patients were treated with the O'Conor technique 6 weeks to 48 mon ths (median 8 weeks) after fistula diagnosis. Results: The vesicovaginal fistula was successfully corrected in all patien ts at the first attempt and only 1 had stress urinary incontinence associat ed with urethral incompetence. No significant bladder dysfunction or decrea se in bladder capacity was seen after repair. Conclusions: Considering the inferior clinical results of the transvaginal and transvesical approaches compared to the O'Conor technique for repair of supratrigonal vesicovaginal fistula, it would be unethical to conduct a ra ndomized study to prove the superiority of the latter method. We suggest th at the O'Conor technique be considered the gold standard surgical method of repair of supratrigonal vesicovaginal fistulas.