Transurethral suture cystorrhaphy for repair of vesicovaginal fistulas: evolution of a technique.

Technical difficulties in the initially described transurethral repair of vesicovaginal fistulas have led to several modifications in technique. In an uncontrolled trial, these modifications included the use of a suprapubic tract, along with an arthroscope for visualization of the fistula. A large-caliber port is passed per urethram for transurethral instrumentation access. New-generation laparoscopic needle driver technology markedly improves the ease of transurethral suturing. Three previously unreported vesicovaginal fistula patients have had successful resolution of their fistulas after undergoing transurethral repair. Small-diameter vesicovaginal fistulas in selected patients can be successfully repaired by a minimally invasive transurethral suture technique.