Urologiia (Moscow, Russia : 1999) · 2025
[Vesicovaginal fistulas: surgical strategy and rare clinical observations].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Komyakov B K
Аннотация
AIM: To present our experience of surgical management of vesicovaginal fistulas (VVFs).
MATERIALS AND METHODS: From 1996 to 2025, 156 women with VVFs underwent surgical treatment at the Department of Urology, North-Western State Medical University named after I.I. Mechnikov. Age ranged from 21 to 79 years (mean 45.2+/-4.6 years). Recurrent fistulas were observed in 42 (26.9%) patients, who had previously undergone from one to six unsuccessful surgical attempts. The predominant cause of VVF formation was iatrogenic injury to the urinary bladder during gynecological interventions (77.5%). Fistula repair was performed in 140 patients, with a transvaginal approach used in 91.4% of cases. The transabdominal approach was employed in 12 women, including 10 cases with concurrent ureteral reconstruction and 2 performed via laparoscopic approach.
RESULTS: Among 140 patients who underwent fistula closure, success was achieved in 139 cases (99.3%).
DISCUSSION: In our clinic, transvaginal fistula closure is the preferred surgical method for managing vesicovaginal fistulas. We consider it the least traumatic open technique, even compared with its laparoscopic alternative.
CONCLUSION: Transvaginal vesicovaginal fistula closure remains the method of choice for treatment of VVFs. A transabdominal approach, including laparoscopic repair, is justified only when simultaneous ureteral reconstruction is required. Heterotopic cystoplasty is regarded as the most reliable reconstructive option for patients with radiation-induced fistulas.
MATERIALS AND METHODS: From 1996 to 2025, 156 women with VVFs underwent surgical treatment at the Department of Urology, North-Western State Medical University named after I.I. Mechnikov. Age ranged from 21 to 79 years (mean 45.2+/-4.6 years). Recurrent fistulas were observed in 42 (26.9%) patients, who had previously undergone from one to six unsuccessful surgical attempts. The predominant cause of VVF formation was iatrogenic injury to the urinary bladder during gynecological interventions (77.5%). Fistula repair was performed in 140 patients, with a transvaginal approach used in 91.4% of cases. The transabdominal approach was employed in 12 women, including 10 cases with concurrent ureteral reconstruction and 2 performed via laparoscopic approach.
RESULTS: Among 140 patients who underwent fistula closure, success was achieved in 139 cases (99.3%).
DISCUSSION: In our clinic, transvaginal fistula closure is the preferred surgical method for managing vesicovaginal fistulas. We consider it the least traumatic open technique, even compared with its laparoscopic alternative.
CONCLUSION: Transvaginal vesicovaginal fistula closure remains the method of choice for treatment of VVFs. A transabdominal approach, including laparoscopic repair, is justified only when simultaneous ureteral reconstruction is required. Heterotopic cystoplasty is regarded as the most reliable reconstructive option for patients with radiation-induced fistulas.