title: Management of genitourinary fistula.
abstract: OBJECTIVE
  To review current literature on the management of genitourinary fistulae, specifically, the techniques for diagnosis, timing to repair, surgical approach and recent advancements in surgical technique.
  
  
  RESULTS
  Recent advancement in minimally invasive surgery has prompted surgeons to perform fistula repairs with laparoscopic or robotic-assisted laparoscopic techniques. Whereas there is a role for transabdominal fistula closure, the majority of fistulae are still best approached via a transvaginal route.
  
  
  CONCLUSIONS
  Genitourinary fistulae from obstetric trauma have received increased attention and funding to treat and prevent this devastating condition in developing countries. Despite multiple classification systems, a standardized classification that accurately identifies predictors of successful repair is lacking. In industrialized nations, genitourinary fistulae are rare and are most frequently associated with pelvic surgery, pelvic radiation, cancer or trauma. Surgical techniques to repair these fistulae have shifted from transabdominal laparotomy to minimally invasive laparoscopic procedures. Vascularized tissue flaps can play an important role in successful closure of complex fistulae. Despite advancements in surgical technology, overarching principles of fistula closure remain. The majority of fistulae can be closed through a transvaginal approach, with a tension-free, watertight, multilayer closure.
authors.affiliation: Department of Obstetrics & Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Mellano
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Tarnay
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D007744:Obstetric Labor Complications / Q000601:surgery*; D011182:Postoperative Care; D011247:Pregnancy; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures; D014719:Vesicovaginal Fistula / Q000175:diagnosis / Q000601:surgery*