A method for the repair of vesicovaginal fistulas

Objective: To determine the efficacy of the sliding layers method for repai ring vesicovaginal fistulas caused by surgical trauma. Method: Twenty one w omen suffering from vesicovaginal fistulas after surgical trauma, operated on between 1990 and 1995 using the sliding layers method, were included in an uncontrolled prospective study and followed 24 months after the procedur e. Patient outcome was assessed according to subjective estimation, gynecol ogical examination and objectively by instillation of diluted methylene blu e to the urinary bladder. Results: Sixteen out of 21 patients suffered vesi covaginal fistulas after being subjected to abdominal hysterectomy and five patients after vaginal surgery. Fourteen fistulas were located 5 to 10 mm over the interureteric edge, five fistulas were in the trigone and two fist ulas were in the bladder neck region. Fistula size ranged from 5 to 35 mm i n diameter but 72.1% of patient fistulas were less than 10 mm in diameter. Only one patient had a large bladder defect of 35 mm in diameter. According to subjective estimation and objective assessment the overall success rate of the procedure after 2 years was 95.2%. Only one patient had to be subje cted to a second successful attempt for fistula closure. Conclusion: The sl iding layers method is a safe and reliable vaginal surgical approach for th e repair of vesicovaginal fistulas after surgical trauma. (C) 2001 Internat ional Federation of Gynecology and Obstetrics. All rights reserved.