Vesicovaginal fistula.

The most common cause of vesicovaginal fistula (VVF) in North America is injury to the bladder during a hysterectomy. In underdeveloped countries, childbirth is the leading etiology of these fistulae. Although the diagnosis of a VVF usually can be readily made in an outpatient setting, care must be exercised not to overlook a second fistula or concomitant ureteral injury. The timing of repair of the VVF is dependent on its etiology, comorbidities, and the anticipated approach for repair of the fistula. The transvaginal approach is more amenable to an early repair, is less invasive, and is accompanied by a 90% or higher success rate. Fistulae related to pelvic irradiation and recurrent fistulae are complex and may require interposition of vascularized tissue for successful repair.