Surgical treatment of vesicovaginal fistulas: Evolution of the concept

Eliseev D.E.¹, Alekseev B.Ya.^1,2, Kachmazov A.A.^1
1  Research Institute of Urology and Interventional Radiology named after N.A. Lopatkin - a branch of the Federal Medical University «National Medical Research Radiological Center»
² Physicians' Continuing Education Institute of Moscow State University of Food Production
Vesicovaginal fistula is one of the most significant and distressing complications in gynecology and oncogynecology. A vesicovaginal fistula is an abnormal communication between the bladder and vagina. Since the seventeenth century surgical methods for treating vesicovaginal fistulas have been continued to develop. There are three surgical approaches for the treatmen of vesicovaginal fistulas: transvesical, transabdominal and transvaginal. The article presents an overview of surgical methods of treating and their evolution from the method of refreshment to the method of splitting. Special attention is paid to the treatment of complicated vesicovaginal fistulas. Complex vesicovaginal fistulas include those associated with prior irradiation or malignancy, recurrent fistulas, fistulas with large size. In these cases the standard transvaginal or transabdominal techniques must be modified. Many techniques of tissue interposition have been described. These provide an additional layer when suturing and improve the quality of the reconstruction. The ideal technique for surgical treatment of vesicovaginal fistulas is the one that ensures the best results with a minimal invasion. New techniques, such as laparoscopy or robotic surgery, can reduce the surgical abdominal injuries.

Key words: vesicovaginal fistula, vaginal approach, abdominal approach, fistuloplasty, interposition of flaps.
For citation: Eliseev D.E., Alekseev B.Ya., Kachmazov A.A. Surgical treatment of vesicovaginal fistulas: Evolution of the concept // RMJ. 2017. № 8. P. 510–514.