title: Combined vagino-abdominal approach for management of vesicovaginal fistulas: a 10 years' experience.
abstract: BACKGROUND
  Vesicovaginal fistulas (VVF) are an uncommon but serious complication of gynecological surgery. The aim of this study was to report our experience with the repair of VVF using combined vaginal and extraperitoneal abdominal approaches.
  
  
  METHODS
  Between 2000 and 2012, 15 consecutive females with VVF were managed with combined vaginal and extraperitoneal abdominal procedures. After assessment by voiding cystourethrography and urethrocystoscopy, the operation was performed at the standard lithotomy position.
  
  
  RESULTS
  Fifteen patients were included in this study with mean age 51.8 ± 11.9 years. The mean fistula size was 2.1 ± 0.7 cm and all of them were located in supra-trigonal region except one case that fistula defect extend to the bladder trigon. Fourteen patients reported complete resolution of urinary incontinence during mean follow-up of 3.5 years. Fistula was recurred in one female 1 year after repair due to cancer recurrence and radiotherapy treatment. No intraoperative complication including massive bleeding or ureteral damage was observed.
  
  
  CONCLUSIONS
  Our experience with combined vaginal and extraperitoneal abdominal repair of a vesicovaginal fistula shows its feasibility and safety with good results.
authors.affiliation: Urology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Razi
authors.forename: Mohammad Mohsen
authors.initials: MM
authors.lastname: Mazloomfard
authors.forename: Hossein
authors.initials: H
authors.lastname: Ajami
authors.forename: Aida
authors.initials: A
authors.lastname: Moeini
mesh_terms: D000328:Adult; D000368:Aged; D003558:Cystoscopy / Q000379:methods; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D014513:Ureter / Q000473:pathology; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*