Surgical repair of vesicovaginal fistulae - A ten-year retrospective study

Objective: Vesicovaginal fistulae in the western world generally occur as c omplications to pelvic surgery or radiation therapy of pelvic cancers. We h ave reviewed our results of vesicovaginal fistula closure procedures over a 10-year period. Patients and Methods: From 1985 to 1996, 55 patients were referred to our department due to vesicovaginal fistulae. Five patients had fistulae due to malignant recurrence and one patient was considered inoper able. Thus, 49 patients were operated on. Thirty patients had fistulae resu lting from pelvic surgery. Nineteen of the 25 patients admitted with fistul ae secondary to radiation therapy of pelvic cancers were operated on. Resul ts: Of the 30 patients with postoperative fistulae, 23 had an abdominal rep air and 7 a vaginal repair. A success rate of 90% was achieved after a firs t closure procedure, as 3 patients within a month experienced a recurrence. These three recurrences were all successfully closed in a second operation , augmenting the success rate to 100% in this group of patients. In the gro up of patients with fistulae caused by irradiation, a urinary diversion was performed in 12 patients, and in 7 patients a primary attempt to close the fistula was made, either by an abdominal approach (2 patients) or by a vag inal approach (5 patients). The fistula recurred in 6 of these 7 patients. Despite several additional attempts to close the recurrent fistulae, only o ne patient was successfully operated on. Conclusion: It seems that vesicova ginal fistulae resulting from pelvic surgery, in our hands, can be managed successfully either by an abdominal or vaginal approach. For patients with vesicovaginal fistulae resulting from radiation therapy, a urinary diversio n appears to be the method of choice.