title: Trans-vaginal repair of gynecological supratrigonal vesicovaginal fistulae: A worthy option!
abstract: OBJECTIVE
  To determine the appropriateness of vaginal approach for gynecological supratrigonal vesicovaginal fistulae.
  
  
  METHODS
  Retrospective review of consecutive women with gynecological supratrigonal Vesico Vaginal Fistulae (VVF) repaired at the fistula unit of Urogynecology department between 1996 and 2011 was done.Out of 48 cases of supratrigonal VVF of gynecological origin identified; 34 (70.8%) cases were repaired vaginally and 14 (36.8%) abdominally with a mean follow-up period of 52.8 (2-132) months.
  
  
  RESULTS
  Overall 95.8% were successfully cured at first attempt. The success rate of vaginal repair (94.8%) at first attempt was comparable to that of abdominal repair (100%) (P value = 0.8946). Amongst two failed vaginal repairs, one was successfully cured by subsequent vaginal repair and other by abdominal repair.
  
  
  CONCLUSIONS
  Three fourth gynecological supratrigonal VVF can be repaired vaginally in first attempt with success rate comparable to abdominal approach. On the basis of this study we postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible supratrigonal VVF of gynecological origin.
authors.affiliation: Department of Urogynaecology, Government Kasturba Gandhi Hospital and Institute of Social Obstetrics, Madras Medical College, Triplicane, Chennai, Tamil Nadu, India.
authors.forename: N
authors.initials: N
authors.lastname: Rajamaheswari
authors.forename: Archana Bharti
authors.initials: AB
authors.lastname: Chhikara
authors.forename: K
authors.initials: K
authors.lastname: Seethalakshmi
authors.forename: Anupama
authors.initials: A
authors.lastname: Bail
authors.forename: Sugandha
authors.initials: S
authors.lastname: Agarwal