title: Urethrovaginal fistula closure.
abstract: OBJECTIVE
  In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula.
  
  
  METHODS
  The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair.
  
  
  RESULTS
  The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure.
  
  
  CONCLUSIONS
  Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.
authors.affiliation: Department of Urology, 9500 Euclid Avenue/ Q10-1, Cleveland, OH, 44195, USA. marisameyerclifton@gmail.com.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Clifton
authors.affiliation: Department of Urology, 9500 Euclid Avenue/ Q10-1, Cleveland, OH, 44195, USA.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D004210:Dissection / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D053825:Suburethral Slings; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery*; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D014624:Vaginal Fistula / Q000150:complications / Q000601:surgery*
keywords: Suburethral sling; Vaginal fistula; Vaginal surgery