title: Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach.
abstract: OBJECTIVE
  We aim to present our experience for the repair of vesicovaginal fistula (VVF) with special reference to surgical approach.
  
  
  METHODS
  From January 1999 to June 2005, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms.
  
  
  RESULTS
  Thirty-two (61.5%) had simple fistulas and 20 (38.5%) complex fistulas. The most common etiology was obstetric trauma in 31 (59.6%) patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5%) patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5%) patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2%) patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2%) complained of mild to moderate dyspareunia.
  
  
  CONCLUSIONS
  Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates.
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: M S
authors.initials: MS
authors.lastname: Ansari
authors.forename: Pratipal
authors.initials: P
authors.lastname: Singh
authors.forename: Parag
authors.initials: P
authors.lastname: Gupta
authors.forename: Naval
authors.initials: N
authors.lastname: Khurana
authors.forename: Anil
authors.initials: A
authors.lastname: Mandhani
authors.forename: Deepak
authors.initials: D
authors.lastname: Dubey
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Anant
authors.initials: A
authors.lastname: Kumar