title: Transvaginal repair of the posthysterectomy vesicovaginal fistula using a peritoneal flap: the gold standard.
abstract: OBJECTIVE
  To evaluate the transvaginal approach to management of vesicouterine fistulas.
  
  
  METHODS
  Over a 10-year period, 7 cases of simple posthysterectomy vesicovaginal fistulas were identified. The surgical technique involved resection of the fistulous tract completely, performance of layered closure and placement of a peritoneal flap between the bladder and vaginal suture lines.
  
  
  RESULTS
  One fistula closed spontaneously, and the remaining 6 were repaired transvaginally. Primary repair was successful in all cases, with no complications.
  
  
  CONCLUSIONS
  The transvaginal repair described is the preferred method of repair, associated with an extremely high success rate, low morbidity and cost savings. Its approach should be considered the gold standard.
authors.affiliation: Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Brody Building, Room 2S-12, Greenville, NC 27834, USA. lentzs@mail.ecu.edu
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Lentz
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000209:etiology* / Q000601:surgery*