Vesicovaginal Fistula: Tips and Tricks of Vaginal Repair

Objectives: This case highlights the utility and surgical technique of using a pediatric foley catheter and stay sutures to achieve descensus in a high vesicovaginal fistula for a successful vaginal repair.

Methods: A 32 year old nulliparous female underwent abdominal hysterectomy with ovarian preservation for pelvic pain at an outside institution. Her surgery was complicated by a cystotomy and repair with subsequent ureteral stricturing requiring placement of a right ureteral stent. Further exacerbating her postoperative course she developed a hematoma with facial dehiscence and evisceration requiring yet another return to the operating room. Her recovery was further complicated by development of continuous urinary leakage. Pelvic examination and CT scan revealed a vesicovaginal fistula at the vaginal apex with minimal apical descensus.

In this video, we demonstrate a step-wise surgical video to successfully repair a high vesicovaginal fistula.

Clinical Relevance: Vaginal approach to vesicovaginal fistula is the preferred route due to lower morbidity, shorter operative time and lower blood loss. In fact, 90% of vesicovaginal fistulas are successfully repaired by the vaginal route. Although high fistulas may appear to be not ideally suited to vaginal repair, adequate descensus can usually be achieved with paralysis and maneuvers to bring the effective apical vaginal segment towards the introitus.