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Vesicovaginal Fistula Repair: Abdominal Approach

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Female Genitourinary and Pelvic Floor Reconstruction

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Abstract

Vesicovaginal fistulae have enormous worldwide impact. This chapter provides an evidence-based review of abdominal repair for vesicovaginal fistulae (VVF). Effective management is underpinned by an appreciation of the underlying pathophysiology of VVF and performance of a thorough clinical evaluation prior to embarking on repair. This is particularly important as the first repair is generally the most successful.

Aetiology is varied, with different patterns seen in lower resourced countries (predominantly obstetric related) compared with well-resourced countries (primarily iatrogenic). Abdominal repair is a versatile approach that is suitable for many fistulae. It can be performed via an open or minimally invasive technique and allows for concomitant adjunct procedures where required, such as ureteric reimplant. Guiding principles and a step-by-step guide for transabdominal repair are provided here.

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References

  1. Zacharin RF. A history of obstetric vesicovaginal fistula. Aust N Z J Surg. 2000;70:851–4.

    Article  CAS  PubMed  Google Scholar 

  2. Tebeu PM, Fomulu JN, Khaddaj S, et al. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23:387–94.

    Article  PubMed  Google Scholar 

  3. Mulete M, Rasmussen S, Kiserud T. Obstetric fistula in 14,928 Ethiopian women. Acta Obstet Gynecol Scand. 2010;89(7):945–51.

    Article  Google Scholar 

  4. Wilson SM, et al. Psychological symptoms among obstetric fistula patients compared to gynecology outpatients in Tanzania. Int J Behav Med. 2015;22(5):605–13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gharoro EP, Agholor KN. Aspects of psychosocial problems of patients with vesico-vaginal fistula. J Obstet Gynaecol. 2009;29(7):644–7.

    Article  CAS  PubMed  Google Scholar 

  6. Olukemi Bello O, et al. Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers. Pan African Medical Journal. 2020;36:22.

    Google Scholar 

  7. USAID. United States Agency International Development (USAID). USAID’S Fistula Program. 2015; p. 1–3.

    Google Scholar 

  8. Lewis L, Wall. Obstetric vesicovaginal fistula as an international public-health problem. Lancet. 2006;368:1201–9.

    Article  Google Scholar 

  9. Adler AJ, Ronsmans C, et al. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013;13:246.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study. Lancet Global Health Oct. 2019;7:1375–87.

    Article  Google Scholar 

  11. Cromwell D, Hilton P. Retrospective cohort study on patterns of care and outcomes of surgical treatment for lower urinary-genital tract fistula among English National Health Service hospitals between 2000 and 2009′. BJU Int. 2013;111:E257–62.

    Article  PubMed  Google Scholar 

  12. Hillary CJ, Osman NI, Hilton P, Chapple CR. The aetiology, treatment, and outcome of urogenital fistulae managed in well- and low-resourced countries: a systematic review. Eur Urol. 2016;70:478–92.

    Article  PubMed  Google Scholar 

  13. Hilton P. Trends in the aetiology of urogenital fistula: a case of retrogressive evolution. Int Urogynecol J. 2016;27:831–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bangash K, Amin O, Luqman S, Hina H. Rising trends in iatrogenic urogenital fistula: a new challenge. Int J Gynaecol Obstet. 2020;148(Suppl 1):33–6.

    PubMed  PubMed Central  Google Scholar 

  15. Raassen TJIP, Ngongo CJ, Mahendeka MM. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. Int Urogynecol J. 2014;25:1699–706.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rogers RG, Jeppson PC. Current diagnosis and management of pelvic fistulae in women. Obstet Gynecol. 2016;128:635–50.

    Article  PubMed  Google Scholar 

  17. Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstetrics Gynaecology Survey. 1996;51:568–74.

    Article  CAS  Google Scholar 

  18. Angioli R, Penalver M, Muzii L, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol. 2003;48(3):295–304.

    Article  PubMed  Google Scholar 

  19. Bora GS, Singh S, Mavuduru RS, Devana SK, et al. Robot-assisted vesicovaginal fistula repair: a safe and feasible technique. Int Urogynecol J. 2017;28:957–62.

    Article  PubMed  Google Scholar 

  20. Forsgren C, Altman D. Risk of pelvic organ fistula in patients undergoing hysterectomy. Current Opinion Obstetrics Gynaecology. 2010;22(5):404–7. https://doi.org/10.1097/GCO.0b013e32833e49b0. PMID: 20739885

    Article  Google Scholar 

  21. Hilton P, Cromwell DA. The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service--a retrospective cohort study examining patterns of care between 2000 and 2008. Br J Obstet Gynaecol. 2012;119(12):1447–54.

    Article  CAS  Google Scholar 

  22. Thayalan K, Parghi S, Krause H, Goh J. Vesicovaginal fistula following pelvic surgery: our experiences and recommendations for diagnosis and prompt referral. Aust N Z J Obstet Gynaecol. 2020;60:449–53.

    Article  PubMed  Google Scholar 

  23. Pushkar DY, Dyakov VV, Kasyan GR. Management of radiation-induced vesicovaginal fistula. Eur Urol. 2009;55:131–7.

    Article  PubMed  Google Scholar 

  24. Massinde A, Kihunrwa A. Large vesico-vaginal fistula caused by a foreign body. Ann Med Health Sci Res. 2013;3(3):456–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Puppo A, Naselli A, Centurioni MG. Vesicovaginal fistula caused by a vaginal foreign body in a 72-year-old woman: case report and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1387–9.

    Article  PubMed  Google Scholar 

  26. Chapman GW. An unusual intravaginal foreign body. J Natl Med Assoc. 1984;76:811–2.

    PubMed  PubMed Central  Google Scholar 

  27. Ichihara K, Masumori N, Takahashi S, et al. Bladder neck rupture and vesicovaginal fistula associated with pelvic fracture in female. Low Urin Tract Symptoms. 2015;7(2):115–7.

    Article  PubMed  Google Scholar 

  28. Sims JM. On the treatment of vesico-vaginal fistula. 1852. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9:236.

    Article  CAS  PubMed  Google Scholar 

  29. Streit–Ciećkiewicz D, Nowakoski L. Predictive value of classification systems and single fistula-related factors in surgical management of vesicovaginal fistula. Neurourol Urodyn. 2021;40(1):529–37.

    Article  PubMed  Google Scholar 

  30. Cromwell D, Hilton P. Retrospective cohort study on patterns of care and outcomes of surgical treatment for lower urinary-genital tract fistula amoung English National Helath Service hospitals between 2000 and 2009. BJU Int. 2013;111:E257–62.

    Article  PubMed  Google Scholar 

  31. Seth J, Kiosoglous A, Pakzad M, Hamid R, Shah J, Ockrim J, Greenwell T. Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: report of a series from a specialized center. Int J Urol 2019. 2019;26(7):717–23.

    Google Scholar 

  32. Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years experience. J Urol. 1980;123:370–4.

    Article  CAS  PubMed  Google Scholar 

  33. Rovner E. Urinary tract fistulae. In: Wein AJ, Kavoussi LR, Novick AC, editors. Campbell-Walsh urology, vol. 3. Philadelphia: Saunders Elsevier; 2012. p. 2223–61.

    Chapter  Google Scholar 

  34. Yu NC, Raman SS, Patel M, Barbaric Z. Fistulas of the genitourinary tract: a radiologic review. Radiographics. 2004;24:5.

    Article  Google Scholar 

  35. Outwater E, Schiebler ML. Pelvic fistulas: findings on Mr. images. AJR Am J Roentgenol. 1993;160:327–30.

    Article  CAS  PubMed  Google Scholar 

  36. Narayanan P, Nobbenhuis M, Reynolds KM, Sahdev A, Reznek RH, Rockall AG. Review fistulas in malignant gynecologic disease: etiology, imaging, and management. Radiographics. 2009;29(4):1073–83.

    Article  PubMed  Google Scholar 

  37. Mandava A, Koppula V, Sharma G, Kandati M, Raju KVVN, Subramanyeshwar RT. Evaluation of genitourinary fistulas in pelvic malignancies with etiopathologic correlation: role of cross-sectional imaging in detection and management. Br J Radiol. 2020;93(1111):20200049. https://doi.org/10.1259/bjr.20200049. Epub 2020 Jun 15. PMID: 32539548; PMCID: PMC7336052.

  38. Hyde BJ, Byrnes JN, Occhino JA, Sheedy SP, VanBuren WM. MRI review of female pelvic fistulizing disease. J Magn Reson Imaging. 2018;48:1172–84.

    Article  PubMed  Google Scholar 

  39. Volkmer BG, Kuefer R, Nesslauer T, Loeffler M. Colour Doppler ultrasound in vesicovaginal fistulas. Study Ultrasound Med Biol. 2000;26(5):771–5.

    Article  CAS  PubMed  Google Scholar 

  40. Sohail S, Siddiqui KJ. Trans-vaginal sonographic evaluation of vesicovaginal fistula. J Pak Med Assoc. 2005;55(7):292–4.

    PubMed  Google Scholar 

  41. Lee D, Zimmern P. Vaginal approach to vesicovaginal. Urol Clin N Am. 2019;46:123–33.

    Article  Google Scholar 

  42. Persky L, Herman G, Guerrier K. Non delay in vesicovaginal fistula repair. Urology. 1979;13(3):273–5.

    Article  CAS  PubMed  Google Scholar 

  43. Randazzo M, Lengauer L, Rochat CH, Ploumidis A, Kropfl D, Rassweiler J, Buffi NM, Wiklund P, Mottrie A, John H. Best practices in robotic-assisted repair of vesicovaginal fistula: a consensus report from the European Association of Urology Robotic Urology Section Scientific Working Group for Reconstructive Urology. Eur Urol. 2020;78:432–42.

    Article  PubMed  Google Scholar 

  44. Rajaian S, Pragatheeswarane M, Panda A. Vesicovaginal fistula: review and recent trends. Indian J Urol. 2019;35:250–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Warner R, Beardmore-Gray A, Pakzad M, Hamid R, Ockrim J, Greenwell T. The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae. Int Urogynecol J. 2020;31:1363–9.

    Article  PubMed  Google Scholar 

  46. Frajzyngier V, Ruminjo J, Asiimwe F, Barry T, Bello A. Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study. BJOG. 2012;119:1344–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Blaivas JG. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153:1110–3.

    Article  CAS  PubMed  Google Scholar 

  48. Mancini M, Righetto M, Modonutti D, Morlacco A, Dal Moro F, Zattoni F, et al. Successful treatment of vesicovaginal fistulas via an abdominal transvesical approach: a single-center 50-yr experience. Eur Urol Focus. 2020;7(6):1485–92.

    Article  PubMed  Google Scholar 

  49. O’Conor VJ Jr. Review of experience with vesicovaginal fistula repair. J Urol. 1980;123:367–9.

    Article  PubMed  Google Scholar 

  50. Chapple C, Turner-Warwick R. Vesicovaginal fistula. BJU Int. 2005;95:193–214.

    Article  PubMed  Google Scholar 

  51. Hellenthal NJ, Nanigian DK, Ambert L, Stone AR. Limited anterior cystotomy: a useful alternative to the vaginal approach for vesicovaginal fistula repair. Urology. 2007;70(4):797–8.

    Article  PubMed  Google Scholar 

  52. Shak TP, Nikolavsky D, Terlecki R, Flynn BJ. Is tissue interposition always necessary in transvaginal repair of benign, recurrent vesicovaginal fistulae? Urology. 2013;82(3):707–12.

    Article  Google Scholar 

  53. Altaweel W, Rajih E, Alkhudair W. Interposition flaps in vesicovaginal fistula repairs can optimize cure rate. Urol Ann. 2013;5(4):270–2.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: an update. Indian Journal of Urology. 2007;23(2):187–91. https://doi.org/10.4103/0970-1591.32073.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Sotelo R, Moros V, et al. Robotic repair of vesicovaginal fistula. BJUI. 2012;109; 9:1416–34.

    Article  Google Scholar 

  56. Melamud O, Eichel L, et al. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. 2005;65(1):163–6.

    Article  CAS  PubMed  Google Scholar 

  57. WHO recommendation on duration of bladder catheterization after surgical repair of simple obstetric urinary fistula.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia

    F. Reeves

  2. Counties Manukau and Auckland Hospital, Auckland, New Zealand

    A. Lawrence

Authors
  1. F. Reeves
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  2. A. Lawrence
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Correspondence to A. Lawrence .

Editor information

Editors and Affiliations

  1. University of Lisbon, Lisbon, Portugal

    Francisco E. Martins

  2. University of Oslo, Oslo, Norway

    Henriette Veiby Holm

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jaspreet Sandhu

  4. Eastern Virginia Medical School, Norfolk, VA, USA

    Kurt A McCammon

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Reeves, F., Lawrence, A. (2023). Vesicovaginal Fistula Repair: Abdominal Approach. In: Martins, F.E., Holm, H.V., Sandhu, J., McCammon, K.A. (eds) Female Genitourinary and Pelvic Floor Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-71112-2_45-1

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  • DOI: https://doi.org/10.1007/978-3-030-71112-2_45-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-71112-2

  • Online ISBN: 978-3-030-71112-2

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