Vesico-vaginal fistula: report of 220 cases.
OBJECTIVE
To present the major causes, diagnosis, indications, and basic principles of surgical treatment of vesico-vaginal fistulas (VVF).


METHODS
From 1978 to 2004, 235 surgical procedures in 220 women with vesico-vaginal fistulas were performed at the Clinical Center of Serbia, Urological Clinic, due to primary or recurrent VVF. There were 220 primary procedures: 129 transvesical approaches (TVES), 59 transvaginal repairs (TVAG), and 32 transperitoneal approaches with flap interposition (TPA). Transvesical approach was the most common procedure in the early period (1978-1993) and less frequent in the late period (1994-2004). The main causes of VVF were hysterectomy for benign conditions (62.7%), hysterectomy for malignant conditions (30.4%), cesarean section (5.9%), and obstetric injuries (0.9%).


RESULTS
There was no perioperative mortality. There were fifteen recurrent fistula formations: twelve after the first operation and three after the second. The recurrence rates between the procedures were comparable: TVES 6.6%, TVAG 6.4%, and TPA 5.4%.


CONCLUSIONS
The total recurrence rate of 6.4% did not differ significantly between various procedures. However, TVAG is less invasive and suitable for uncomplicated cases, whereas TPA should be recommended for great and recurrent VVF.
Hadzi-Djokic
Jovan
J
Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia.
Pejcic
Tomislav P
TP
Acimovic
Miodrag
M
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D055771:Serbia; D013524:Surgical Flaps; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*