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Vesicovaginal Fistula
Updated: Oct 1, 2009
Introduction
Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF). VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. In addition to the medical sequelae from these fistulas, they often have a profound effect on the patient's emotional well-being. This article reviews the etiology of VVF, the surgical principles of repair, and the techniques developed for their repair.
History of the Procedure
The earliest evidence of a VVF was found in 1923, when Derry examined the mummified body of Henhenit, a lady in the court of Mentuhotep of the 11th dynasty who reigned around 2050 BC. These dissections revealed a large VVF in a markedly contracted pelvis. The Kahun papyrus and Ebers papyrus failed to mention VVF. However, not until 950 AD did Avicenna correlate the combination of pregnancy at a young age and difficult labor with the formation of a vesicovaginal communication. The term fistula (previously called ruptura) was not used until 1597, when Luiz de Mercado first coined the term.
The first basic surgical principles for the repair of VVFs were described in 1663 by Hedrik von Roonhuyse. He stressed the use of a speculum and the lithotomy position to gain adequate exposure and denudation of the margin of the bladder wall, with reapproximation of the edges using sharpened swan quills. Later, using Roonhuyse's technique, Johann Fatio documented the first successful VVF repair in 1675. However, not until the 19th century did successful repair of VVFs become common. In 1834, Jobert de Lamballe published a report of his VVF repairs in which skin flaps were used in the vagina. Later, he advocated the use of tension-free closures using vaginal-releasing incisions.1
James Marion Sims published his famous discourse on the treatment of VVF in 1852.2 Using leaden or silver wire, as John Peter Mettauer had done successfully in 1838, Sims achieved success on his 30th surgical attempt on a slave named Anarcha. Sims emphasized the importance of good exposure, adequate resection of the fistula and scarred vaginal edges, and the critical importance of continuous postoperative bladder drainage. Sims disparaged the popular technique of coagulation (by the application of silver nitrate), stating it proved entirely ineffective except in the rare case of a very small fistula.
In 1861, Maurice Collis was the first to report a layered closure technique3 , and in 1893, Schuchardt described a pararectal incision to facilitate improved exposure for the repair of a high VVF4 . Trendelenburg, in 1881-1890, described a suprapubic approach.5 Maisonneuve6 and Mackenrodt7 each described the key technique that involves separating the bladder from the vaginal mucosa and suturing each layer individually. The famous gynecologist, Dr. Kelly also described both a vaginal repair of VVF in 1896, and a suprapubic closure in 1906. Dr Kelly also advocated the use of preoperative ureteral catheters to minimize the risk of ureteral injury.
During the early 20th century, several additional techniques were used to improve outcome for the repair of VVF. In 1942, Latzko published his partial colpocleisis technique for repair of posthysterectomy VVF, in which he used the resection of scarred vaginal mucosa and a layered horizontal closure.8 Latzko's procedure has been cited, with his 95-100% success rates noted, in numerous surgeons' experiences. In 1950, O'Conor and Stovsky popularized the transabdominal approach and also proposed the use of electrocoagulation as an initial treatment modality in women with VVFs of 3.5 mm or less, citing a 73% success rate.
Additionally, numerous surgeons are credited for the development of various flaps for interposition between the bladder and vaginal walls to minimize the failure of VVF repairs. The list includes Garlock in 19289 (pedicled gracilis muscle flap), Martius in 192810 (pedicled bulbocavernosus flap), Ingelman-Sundberg in 196011 (pubococcygeus, bulbocavernosus, rectus abdominis, and gracilis), and Kiricuta and Goldstein in 197212 (pedicled omental flaps).
This historical outline of surgical advances is by no means complete. Countless surgeons not listed above have helped raise awareness of VVF with the public and in the medical community, while making substantial contributions in the research and surgical management of this morbid condition.
Problem
A VVF is an abnormal communication between the urinary bladder and the vagina that results in the continuous involuntary discharge of urine into the vaginal vault. An accurate diagnosis is paramount before consideration of repair. A variety of methods are available to the clinician, and any excessive or suspicious vaginal discharge in a patient who recently underwent pelvic surgery or who has a history of pelvic radiotherapy should be evaluated promptly for a UGF.
Frequency
In developing countries, the predominant cause of VVF is prolonged obstructed labor (97%). VVFs are associated with marked pressure necrosis, edema, tissue sloughing, and cicatrization. The frequency of VVF is largely underreported in developing countries.
The magnitude of the fistula problem worldwide is unknown but believed to be immense. In Nigeria alone, Harrison (1985) reported a vesicovaginal fistula rate of 350 cases per 100,000 deliveries at a university teaching hospital. The Nigerian Federal Minister for Women Affairs and Youth Development, Hajiya Aish M.S. Ismail, has estimated that the number of unrepaired VVFs in Nigeria is between 800,000 and 1,000,000 (2001). In 1991, the World Health Organization identified the following geographic areas where obstetric fistula prevalence is high: virtually all of Africa and south Asia, the less-developed parts of Oceana, Latin America, the Middle East, remote regions of Central Asia, and isolated areas of the former Soviet Union and Soviet-dominated eastern Europe.
In contrast to developing countries, countries that practice modern obstetrics have a low rate of UGFs and VVF remains the most common type. Less frequently, UGFs may occur (1) between the bladder and cervix or uterus; (2) between the ureter and vagina, uterus, or cervix; and (3) between the urethra and vagina. Of note, a ureteric injury is identified in association with 10-15% of VVFs.
The majority of UGFs in developed countries are a consequence of gynecological surgery. Consequently, the incidence may change as surgical management changes. The incidence of VVF in the United States is debated. Although most authors quote an incidence rate of VVF after total abdominal hysterectomy (TAH) of 0.5-2%, others suggest only a 0.05% incidence rate of injury to either the bladder or ureter. So if injuries to the bladder and ureters occur in roughly 1% of major gynecologic procedures, and approximately 75% are associated with hysterectomy, and if there are about 500,000 hysterectomies performed each year then about 5,000 women will experience an injury.
Lee, in a series of 35,000 hysterectomies, found more than 80% of genitourinary fistulas arose from gynecological surgery for benign disease. Uncomplicated TAH accounted for more than 70% of these surgeries. The indications for these TAH surgeries excluded the more complex diagnoses, such as pelvic inflammatory disease (PID), endometriosis, and carcinoma; instead, they were performed primarily for diagnoses such as abnormal bleeding, fibroids, and prolapse. In approximately 10% of cases of VVF, obstetrical trauma was the associated etiology. Radiotherapy and surgery for malignant gynecologic disease each accounted for 5% of cases.
Notably, a rise in incidence of UGFs paralleled the switch in policy toward the preference of performing a total hysterectomy over a supracervical hysterectomy.
Etiology
Developing countries
Numerous factors contribute to the development of VVF in developing countries. Commonly, these are areas where the culture encourages marriage and conception at a young age, often before full pelvic growth has been achieved. Chronic malnutrition further limits pelvic dimensions, increasing the risk of cephalopelvic disproportion and malpresentation. In addition, few women are attended by qualified health care professionals or have access to medical facilities during childbirth; their obstructed labor may be protracted for days or weeks.
The effect of prolonged impaction of the fetal presenting part in the pelvis is one of widespread tissue edema, hypoxia, necrosis, and sloughing resulting from prolonged pressure on the soft tissues of the vagina, bladder base, and urethra. Typically in these countries, the UGF is large and involves the bladder, urethra, bladder trigone, and the anterior cervix. Complex neuropathic bladder dysfunction and urethral sphincteric incompetency often result, even if the fistula can be repaired successfully. Other cultural factors that increase the likelihood of obstetrical UGFs include outlet obstruction due to female circumcision and the practice of harmful traditional medical practices such as Gishiri incisions (anterior vaginal wall incisions) and the insertion of caustic substances into the vagina with the intent to treat a gynecologic condition or to help the vagina to return to its nulliparous state.
Developed countries
VVFs in developing countries are attributed predominantly to inadvertent bladder injury during pelvic surgery (90%). They involve a relatively limited focal bladder injury leading to smaller VVFs than are observed in developing countries. Numerous authors highlight the risk of various types of bladder trauma during pelvic surgery. Such injuries include unrecognized intraoperative laceration of the bladder, bladder wall injury from electrocautery or mechanical crushing, and the dissection of the bladder into an incorrect plane, causing avascular necrosis.
Suture placement through the bladder wall in itself may not play a significant role in VVF development. However, the risk of formation of a hematoma or avascular necrosis after a suture is placed through the bladder wall can lead to infection, abscess, and subsequent suture erosion through the bladder wall. This wall defect permits the escape of urine into the vagina and may be followed by an eventual epithelialization of the track.
Gynecologic procedures are the most common iatrogenic factor. Symmonds evaluated 800 genitourinary fistulas over a 30-year period at the Mayo Clinic. Of these, 85% of the VVFs were related to pelvic operations and 75% were related to hysterectomy, with more than 50% being secondary to simple uncomplicated total abdominal or vaginal hysterectomy. Symmonds also found that 5% of these VVFs were obstetric and 10% occurred after radiotherapy. Obstetric UGFs in modern centers include vaginal lacerations from forceps rotations, cesarean delivery, hysterectomy, and ruptured uterus.
Other types of pelvic surgery (eg, urologic, gastrointestinal surgery) also contribute to the incidence of VVFs; such surgeries include suburethral sling procedures, surgical repair of urethral diverticulum, electrocautery of bladder papilloma, and surgery for pelvic carcinomas. Other less common causes of VVFs include pelvic infections (eg, tuberculosis, syphilis, lymphogranuloma venereum), vaginal trauma, and vaginal erosion with foreign objects (eg, neglected pessary). Lastly, a congenital urogenital abnormality may exist that includes a VVF.
Risk factors that predispose to VVFs include prior pelvic or vaginal surgery, previous PID, ischemia, diabetes, arteriosclerosis, carcinoma, endometriosis, anatomic distortion by uterine myomas, and infection, particularly postoperative cuff abscess. Tancer found prior cesarean delivery to be the most common factor predisposing to vault fistula after abdominal surgery in his series of 110 cases; here, 29% were associated with prior cesarean delivery.13 Of interest, Tancer also noted 67% of the VVFs in his series occurred in the absence of any risk factors. He also noted that 24 patients incurred a bladder injury during hysterectomy; the injury was recognized intraoperatively and received immediate intraoperative repair (often by a consulting specialist). Despite prompt identification, treatment, and postoperative continuous bladder drainage for 7-10 days, a VVF could not be averted.
Presentation
The uncontrolled leakage of urine into the vagina is the hallmark symptom of patients with UGFs. Patients may complain of urinary incontinence or an increase in vaginal discharge following pelvic surgery or pelvic radiotherapy with or without antecedent surgery. The drainage may be continuous; however, in the presence of a very small UGF, it may be intermittent. Increased postoperative abdominal, pelvic, or flank pain; prolonged ileus; and fever should alert the physician to possible urinoma or urine ascites and mandates expeditious evaluation. Recurrent cystitis or pyelonephritis, abnormal urinary stream, and hematuria also should initiate a workup for UGF.
The time from initial insult to clinical presentation depends on the etiology of the VVF. A VVF secondary to a bladder laceration typically presents immediately. Approximately 90% of genitourinary fistulas associated with pelvic surgery are symptomatic within 7-30 days postoperatively. An anterior vaginal wall laceration associated with obstetric fistulas typically (75%) presents in the first 24 hours of delivery. In contrast, radiation-induced UGFs are associated with slowly progressive devascularization necrosis and may present 30 days to 30 years later. Patients with radiation-induced VVFs initially present with symptoms of radiation cystitis, hematuria, and bladder contracture.
Indications
Symptomatic VVF merits appropriate treatment. Further details regarding the indications for a specific procedure are described in Surgical objectives or principles.
Contraindications
In general, no absolute contraindications exist for the attempted correction of a VVF in patients who can medically tolerate a surgical procedure.
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 Overview: Vesicovaginal Fistula |
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References
Jobert de Lamballe AJ. Balliere, Fils, eds. Traite Des Fistules Vesico-Uterines. Paris, France: 1852.
Sims JM. On the treatment of vesico-vaginal fistula. 1852. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(4):236-48. [Medline].
Collis M. Further remarks on a new successful mode of treatment for vesicovaginal fistula. Dublin Q J. 1861;31:302-16.
Schuchardt K. Eine neue Methode der Gebarmutterextirpation. Zentralbl Chir. 1893;20:1121.
Trendelenburg F. Discussion zu Helferich. Zuganglichmachung der vorderen Blasenwand. Verbandlung der Deutsche ges F Chir. 1888;17:101.
Maisonneuve J. Clinique Chirurgicale. Paris, France: 1863:660.
Mackenrodt A. Die operative Heilung grosser Blasenscheidenfisteln. Zentralbl Gynakol. 1894;8:180.
Latzko W. Postoperative vesicovaginal fistulas: genesis and therapy. Am J Surg. 1942;58:211-8.
Garlock J. The cure of an intractable vesicovaginal fistula by the use of pedicled muscle graft. Surg Gynecol Obstet. 1928;47:255.
Martius H. Die operative Wiederher-stellung der Volkmmen fehlenden Harnrohre und des Schliessmuskels derselben. Zentralbl Gynakol. 1928;8:480.
Ingelman-Sundberg AGI. Pathogenesis and operative treatment of urinary fistula in irradiated tissue. In: Youssef A, Thomas CC, eds. Gynecological Urology. Springfield, Ill: Charles C Thomas Publishers; 1960:263.
Kiricuta I, Goldstein AM. The repair of extensive vesicovaginal fistulas with pedicled omentum: a review of 27 cases. J Urol. Nov 1972;108(5):724-7. [Medline].
Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet. Dec 1992;175(6):501-6. [Medline].
Andreoni C, Bruschini H, Truzzi JC, Simonetti R, Srougi M. Combined vaginoscopy-cystoscopy: a novel simultaneous approach improving vesicovaginal fistula evaluation. J Urol. Dec 2003;170(6 Pt 1):2330-2. [Medline].
Volkmer BG, Kuefer R, Nesslauer T, Loeffler M, Gottfried HW. Colour Doppler ultrasound in vesicovaginal fistulas. Ultrasound Med Biol. Jun 2000;26(5):771-5. [Medline].
Zimmern PE, Hadley HR, Staskin D. Genitourinary fistulas: vaginal approach for repair of vesicovaginal fistulas. Clin Obstet Gynaecol. Jun 1985;12(2):403-13. [Medline].
Davits RJ, Miranda SI. Conservative treatment of vesicovaginal fistulas by bladder drainage alone. Br J Urol. Aug 1991;68(2):155-6. [Medline].
Elkins T, Thompson J. Lower urinary tract fistulas. In: Walters M, Karram M, eds. Urogynecology and Reconstructive Pelvic Surgery. St Louis, Mo: Mosby; 1999:355-66.
Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol. Dec 2003;48(3):295-304. [Medline].
Margolis T, Mercer LJ. Vesicovaginal fistula. Obstet Gynecol Surv. Dec 1994;49(12):840-7. [Medline].
O'Conor VJ Jr. Review of experience with vesicovaginal fistula repair. J Urol. Mar 1980;123(3):367-9. [Medline].
Carr LK, Webster GD. Abdominal repair of vesicovaginal fistula. Urology. Jul 1996;48(1):10-1. [Medline].
Persky L, Herman G, Guerrier K. Nondelay in vesicovaginal fistula repair. Urology. Mar 1979;13(3):273-5. [Medline].
Blandy JP, Badenoch DF, Fowler CG. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol. Sep 1991;146(3):761-5. [Medline].
Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. Apr 1995;153(4):1110-2; discussion 1112-3. [Medline].
Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. Sep 1988;72(3 Pt 1):313-9. [Medline].
Tomlinson AJ, Thornton JG. A randomised controlled trial of antibiotic prophylaxis for vesico- vaginal fistula repair. Br J Obstet Gynaecol. Apr 1998;105(4):397-9. [Medline].
Elkins TE. Surgery for the obstetric vesicovaginal fistula: a review of 100 operations in 82 patients. Am J Obstet Gynecol. Apr 1994;170(4):1108-18; discussion 1118-20. [Medline].
Raz S. Female Urology. Philadelphia, Pa: WB Saunders; 1893:373-7.
Cruikshank SH. Early closure of posthysterectomy vesicovaginal fistulas. South Med J. Dec 1988;81(12):1525-8. [Medline].
Iselin CE, Aslan P, Webster GD. Transvaginal repair of vesicovaginal fistulas after hysterectomy by vaginal cuff excision. J Urol. Sep 1998;160(3 Pt 1):728-30. [Medline].
Aycinena JF. Small vesicovaginal fistula. Urology. May 1977;9(5):543-5. [Medline].
Elkins TE, DeLancey JO, McGuire EJ. The use of modified Martius graft as an adjunctive technique in vesicovaginal and rectovaginal fistula repair. Obstet Gynecol. Apr 1990;75(4):727-33. [Medline].
Flynn MK, Peterson AC, Amundsen CL, Webster GD. Functional outcomes of primary and secondary repairs of vesicovaginal fistulae via vaginal cuff scar excision. Int Urogynecol J Pelvic Floor Dysfunct. Nov-Dec 2004;15(6):394-8; discussion 398. [Medline].
Weinlechner. Demonstration einer nach der Methode Trendelenburg's ausgefurten Operation einer Vesico-vaginalfistel. Wien Klin Webnschr. 1893;125.
Bardenheuer B. Der Extraperitoneale Explorativschnitt. Stuttgart;1887.
Turner-Warwick R. The use of the omental pedicle graft in urinary tract reconstruction-. J Urol. Sep 1976;116(3):341-7. [Medline].
Dittel V. Abdominale Blasenscheidfistel-Operation. Wien Klin Webnschr. 1803;6:449-52.
Legueu F. De la voie transperitoneo-vesicale pour la cure certaines fistules vesico-vaginales operatoires. Arch Urol Clin De Necker. 1913;1:1-11.
O'Conor V, Sokol J. Vesicovaginal fistula from the standpoint of the urologist. J Urol. 1951;66:579.
Gil-Vernet JM, Gil-Vernet A, Campos JA. New surgical approach for treatment of complex vesicovaginal fistula. J Urol. Mar 1989;141(3):513-6. [Medline].
Coleman JW, Albanese C, Marion D. Experimental use of free grafts of bladder mucosa in canine bladders. Successful closure of recurrent vesicovaginal fistula utilizing bladder mucosa. Urology. May 1985;25(5):515-7. [Medline].
Ostad M, Uzzo RG, Coleman J. Use of a free bladder mucosal graft for simple repair of vesicovaginal fistulae. Urology. Jul 1998;52(1):123-6. [Medline].
Stovsky MD, Ignatoff JM, Blum MD. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol. Nov 1994;152(5 Pt 1):1443-4. [Medline].
Margolis T, Elkins TE, Seffah J. Full-thickness Martius grafts to preserve vaginal depth as an adjunct in the repair of large obstetric fistulas. Obstet Gynecol. Jul 1994;84(1):148-52. [Medline].
Matras H, Dinges HP, Lassmann H. [Suture-free interfascicular nerve transplantation in animal experiments]. Wien Med Wochenschr. Sep 9 1972;122(37):517-23. [Medline].
Matras H. Fibrin seal: the state of the art. J Oral Maxillofac Surg. Aug 1985;43(8):605-11. [Medline].
Pettersson S, Hedelin H, Jansson I. Fibrin occlusion of a vesicovaginal fistula. Lancet. Apr 28 1979;1(8122):933. [Medline].
Hedelin H, Nilson AE, Teger-Nilsson AC. Fibrin occlusion of fistulas postoperatively. Surg Gynecol Obstet. Mar 1982;154(3):366-8. [Medline].
Venkatesh KS, Ramanujam P. Fibrin glue application in the treatment of recurrent anorectal fistulas. Dis Colon Rectum. Sep 1999;42(9):1136-9. [Medline].
Tsurusaki T, Sakai H, Nishikido M. Occlusion therapy for an intractable transplant-ureteral fistula using fibrin glue. J Urol. May 1996;155(5):1698. [Medline].
Sharma SK, Perry KT, Turk TM. Endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. J Endourol. Apr 2005;19(3):419-23. [Medline].
Morita T, Tokue A. Successful endoscopic closure of radiation induced vesicovaginal fistula with fibrin glue and bovine collagen. J Urol. Nov 1999;162(5):1689. [Medline].
Dogra PN, Nabi G. Laser welding of vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):69-70. [Medline].
Nezhat CH, Seidman DS, Nezhat F. Laparoscopic management of intentional and unintentional cystotomy. J Urol. Oct 1996;156(4):1400-2. [Medline].
Sotelo R, Mariano MB, García-Segui A, Dubois R, Spaliviero M, Keklikian W. Laparoscopic repair of vesicovaginal fistula. J Urol. May 2005;173(5):1615-8. [Medline].
Melamud O, Eichel L, Turbow B, Shanberg A. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. Jan 2005;65(1):163-6. [Medline].
McKay HA. Transurethral suture cystorrhaphy for repair of vesicovaginal fistulas: evolution of a technique. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(4):282-7.
Raz S, Bregg KJ, Nitti VW. Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol. Jul 1993;150(1):56-9. [Medline].
Lentz SS. Transvaginal repair of the posthysterectomy vesicovaginal fistula using a peritoneal flap: the gold standard. J Reprod Med. Jan 2005;50(1):41-4. [Medline].
Kanavel A. Plastic procedures for the obliteration of cavities with noncollapsible walls. Surg Gynecol Obstet. 1921;32:453.
Banerji B. Role of musculofascial pedicle graft in operative repair of vesicovaginal fistulae. Int Surg. Apr 1966;45(4):391-6. [Medline].
Menchaca A, Akhyat M, Gleicher N. The rectus abdominis muscle flap in a combined abdominovaginal repair of difficult vesicovaginal fistulae. A report of three cases. J Reprod Med. May 1990;35(5):565-8. [Medline].
Brandt FT, Lorenzato FR, Albuquerque CD. Treatment of vesicovaginal fistula by bladder mucosa autograft technique. J Am Coll Surg. Jun 1998;186(6):645-8. [Medline].
Vyas N, Nandi PR, Mahmood M, Tandon V, Dwivedi US, Singh PB. Bladder mucosal autografts for repair of vesicovaginal fistula. BJOG. Jan 2005;112(1):112-4. [Medline].
el-Lateef Moharram AA, el-Raouf MA. Retropubic repair of genitourinary fistula using a free supporting graft. BJU Int. Mar 2004;93(4):581-3. [Medline].
Alagöl B, Gözen AS, Kaya E, Inci O. The use of human dura mater as an interposition graft in the treatment of vesicovaginal fistula. Int Urol Nephrol. 2004;36(1):35-40. [Medline].
Singh RB, Pavithran NM, Nanda S. Plastic reconstruction of a mega vesicovaginal fistula using broad ligament flaps--a new technique. Int Urogynecol J Pelvic Floor Dysfunct. Feb 2003;14(1):62-3.
Symmonds RE. Incontinence: vesical and urethral fistulas. Clin Obstet Gynecol. Jun 1984;27(2):499-514. [Medline].
Abel ME, Chiu YS, Russell TR. Autologous fibrin glue in the treatment of rectovaginal and complex fistulas. Dis Colon Rectum. May 1993;36(5):447-9. [Medline].
American College of Obstetricians and Gynecologists. Genitourinary Fistulas. ACOG Technical Bulletin. 83:1-6.
Cronkite E, Lozner E, Deaver J. Use of thrombin and fibrinogen in skin grafting. JAMA. 1994;124:976-8.
Elkins TE, Drescher C, Martey JO. Vesicovaginal fistula revisited. Obstet Gynecol. Sep 1988;72(3 Pt 1):307-12. [Medline].
Evans LA, Ferguson KH, Foley JP, Rozanski TA, Morey AF. Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications. J Urol. Apr 2003;169(4):1360-2. [Medline].
Falk H, Tancer M. Vesicovaginal fistula: an historical survey. Obstet Gynecol. 1954;3:337-41.
Fitzpatrick C, Elkins T. Plastic surgical techniques in the repair of vesicovaginal fistulas: a review. Int Urogynecol J. 1993;4:287-95.
Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. Mar 1980;123(3):370-4. [Medline].
Hanash KA, Al Zahrani H, Mokhtar AA. Retrograde vaginal methylene blue injection for localization of complex urinary fistulas. J Endourol. Dec 2003;17(10):941-3.
Huang WC, Zinman LN, Bihrle W 3rd. Surgical repair of vesicovaginal fistulas. Urol Clin North Am. Aug 2002;29(3):709-23. [Medline].
Langkilde NC, Pless TK, Lundbeck F. Surgical repair of vesicovaginal fistulae--a ten-year retrospective study. Scand J Urol Nephrol. Apr 1999;33(2):100-3. [Medline].
Latzko W. Behandlung hochsitzender Blasen und Mastdarmscheiden Fistein nach Uterus Extirpation mit hohem Scheidenverschluss. Zentralbl Gynakol. 1914;38:906.
Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. Jul 2001;11(4):417-21. [Medline].
Nahai F. Muscle and musculocutaneous flaps in gynecologic surgery. Clin Obstet Gynecol. Dec 1981;24(4):1277-317. [Medline].
Nezhat CH, Nezhat F, Nezhat C. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. May 1994;83(5 Pt 2):899-901. [Medline].
Ninkovic M, Dabernig W. Flap technology for reconstructions of urogenital organs. Curr Opin Urol. Nov 2003;13(6):483-8. [Medline].
O'Conor VJ Jr, Sokol JK, Bulkley GJ, Nanninga JB. Suprapubic closure of vesicovaginal fistula. J Urol. Jan 1973;109(1):51-4. [Medline].
Pettit PD, Petrou SP. The value of cystoscopy in major vaginal surgery. Obstet Gynecol. Aug 1994;84(2):318-20. [Medline].
Phadke K, Ballal S, Venkatesh K. Pediatric renal transplantation--Indian experience. Indian Pediatr. Mar 1998;35(3):231-5. [Medline].
Phillips J. Laparoscopic repair of posthysterectomy vesicovaginal fistula: two case reports. Gynaecol Endos. 1996;5:123-4.
Punekar SV, Buch DN, Soni AB, Swami G, Rao SR, Kinne JS, et al. Martius' labial fat pad interposition and its modification in complex lower urinary fistulae. J Postgrad Med. Jul-Sep 1999;45(3):69-73. [Medline].
Rizvi JH. Genital fistulae. A continuing tragedy. J Obstet Gynaecol Res. Feb 1999;25(1):1-7. [Medline].
Robertson J. Vesicovaginal fistula: vaginal repair. In: Ostergard D, Bent A, eds. Urogynecology and Urodynamics: Theory and Principle. Baltimore, Md: Lippincott Williams & Wilkins; 1996:371-4.
Sharifi-Aghdas F, Ghaderian N, Payvand A. Free bladder mucosal autograft in the treatment of complicated vesicovaginal fistula. BJU Int. Mar 2002;89 Suppl 1:54-6. [Medline].
Smith GL, Williams G. Vesicovaginal fistula. BJU Int. Mar 1999;83(5):564-9; quiz 569-70. [Medline].
Tancer ML. A report of thirty-four instances of urethrovaginal and bladder neck fistulas. Surg Gynecol Obstet. Jul 1993;177(1):77-80. [Medline].
von Theobald P, Hamel P, Febbraro W. Laparoscopic repair of a vesicovaginal fistula using an omental J flap. Br J Obstet Gynaecol. Nov 1998;105(11):1216-8. [Medline].
Wall LL, Arrowsmith SD, Briggs ND. The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv. Jul 2005;60(7 Suppl 1):S3-S51.
Warwick RT, Worth P, Milroy E. The suprapubic V-incision. Br J Urol. Feb 1974;46(1):39-45. [Medline].
Wiskind A, Thompson J. Should cystoscopy be performed at every gynecologic operation to diagnose unsuspected ureteral injury?. J Pelvic Surg. 1995;1:134.
Zacharin R. Obstetric Fistula. New York, NY: Springer-Verlag; 1988.
Further Reading
Keywords
vesicovaginal fistula, VVF, urogenital fistula, UGF, female urogenital fistula, gynecologic fistula, female circumcision, symphysiotomy, Gihiri incisions, pelvic surgery, bladder injury, bladder trauma, genitourinary fistula
