title: A 12-year experience in the surgical management of vesicovaginal fistulae.
abstract: BACKGROUND
  Vesicovaginal fistulae are largely iatrogenic and represent therapeutic dilemmas in surgical approach and timing of repairs.
  
  
  OBJECTIVE
  We have reviewed our surgical management of vesicovaginal fistulae over a 12-year period to determine whether the outcome is dependent on surgical approach and timing of repair.
  
  
  METHODS
  From January 1990 to September 2001, 23 patients were referred to our department of whom 20 have retrievable records. Fourteen of these 20 patients had gynaecological operations as the primary cause for their fistulas whilst the remaining six had varied causes ranging from forceps delivery to recurrent pelvic malignancies.
  
  
  RESULTS
  Of 20 patients, four underwent transvaginal repair, seven transvesical repair, eight supravesical repair and one required an ileal conduit diversion. There was an 85% success after first repair with only three fistula recurrences, two of whom underwent a successful second repair and one was treated conservatively and successfully with urethral catheterisation. There were no further recurrences at mean follow-up of 23 months for our cohort. Earlier repair seemed to be associated with a higher recurrence rate (33% of six patients within six weeks) compared with delayed operations (7% of remaining 14 operated after six weeks).
  
  
  CONCLUSIONS
  Vesicovaginal fistulae can be successfully managed surgically. Although the type of approach did not affect outcome, the timing of the repair may affect the success of the operation.
authors.affiliation: Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: M H
authors.initials: MH
authors.lastname: Kam
authors.forename: Y H
authors.initials: YH
authors.lastname: Tan
authors.forename: M Y C
authors.initials: MY
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000175:diagnosis / Q000601:surgery*