Feasibility for transvaginal closure supratrigonal vesicovaginal fistula

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2019. Background: Vesicovaginal fistula (VVF) after a gynecologic procedure is often located at the supratrigonal area. This location is difficult to approach via the vagina because of the depth and exposure. Objective: To demonstrate the outcome of transvaginal closure supratrigonal VVF. Materials and Methods: The authors retrospectively reviewed non-radiated VVF that was repaired transvaginally between 2015 and 2017. A cure was defined as no clinical urinary incontinence and vaginal discharge. Results: Eleven cases were performed transvaginal closure fistula. The average fistula diameter was 5.1 mm. The peritoneal flap and labial fat were used for tissue interposition in five and three cases respectively. Six cases were cured at mean follow-up of 6.8 (1 to 24) months. Five cases recurred and four of them were performed transvaginal closure. The four cases of recurrence were cured at mean follow-up of 7.0 (3 to 10) months. Two cases used peritoneal flap and others used labial fat for tissue interposition. One had recurrence using one pad per day and did not want to repair. The average operative time for 15 repairs was 82.1 (45 to 120) minute. For all 15 repairs, mean length of stay was 4.3 (2 to 11) days and mean catheter time was 19.1 (10 to 54) days. Conclusion: Supratrigonal VVF could be successfully repaired with transvaginal approach. Overall success rate in first attempt was 54.5%.