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Postoperative vesicovaginal fistulas: Genesis and therapy

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      The outcomes of all patients were promising, while one had leaked at the fifth-week follow-up. Latzko familiarised the vaginal approach of vault colpocleisis without any attempt at the dissection of the fistulous tract.10,11 However, using colpocleisis in radiation-induced VVF might not be prudent concerning the poor quality irradiated surrounding tissues leading to the poor abutment.

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      The European Association of Urology guidelines for urinary incontinence suggest catheterization [58]. Historical data suggest spontaneous fistula closure of up to 20% [59]. The ERUS Reconstructive Panel recommends a trial with a catheter for attempting a conservative management of up to 12 wk.

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      The major disadvantage is vaginal shortening with potential interference with sexual activity and risk of failure. The success rate ranges from 89% to 100%.23–25 A catheter placed through the fistula tract aides in pulling down the fistula and in dissecting it all around.

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      In 1928 Martius introduced the concept of interposition flap, being the first using a flap of adipose tissue from the labia majora.12 In 1942 Latzko introduced his VVF transvaginal repair technique, which is still considered by many to be the standard transvaginal approach.13 Around 1950, O'Conor and Sokol described his repair technique with transabdominal approach with wide cystotomy.14

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