PURPOSE: Several techniques have been used for repair of vesicovaginal fistula. Although surgical success is achieved in the majority of cases, a 4 to 35% failure rate occurs when a transvesical or transvaginal approach is used. We investigated the clinical efficacy of the O'Conor transperitoneal supravesical technique for supratrigonal vesicovaginal fistula. MATERIALS AND METHODS: A total of 29 patients with iatrogenic supratrigonal vesicovaginal fistula following hysterectomy or cesarean section were studied. An initial operation and prior attempts at fistula repair had been performed in 9 patients (34%) for benign (26) or malignant (3) uterine conditions. All patients were treated with the O'Conor technique 6 weeks to 48 months (median 8 weeks) after fistula diagnosis. RESULTS: The vesicovaginal fistula was successfully corrected in all patients at the first attempt and only 1 had stress urinary incontinence associated with urethral incompetence. No significant bladder dysfunction or decrease in bladder capacity was seen after repair. CONCLUSIONS: Considering the inferior clinical results of the transvaginal and transvesical approaches compared to the O'Conor technique for repair of supratrigonal vesicovaginal fistula, it would be unethical to conduct a randomized study to prove the superiority of the latter method. We suggest that the O'Conor technique be considered the gold standard surgical method of repair of supratrigonal vesicovaginal fistulas.
PURPOSE: Several techniques have been used for repair of vesicovaginal fistula. Although surgical success is achieved in the majority of cases, a 4 to 35% failure rate occurs when a transvesical or transvaginal approach is used. We investigated the clinical efficacy of the O'Conor transperitoneal supravesical technique for supratrigonal vesicovaginal fistula. MATERIALS AND METHODS: A total of 29 patients with iatrogenic supratrigonal vesicovaginal fistula following hysterectomy or cesarean section were studied. An initial operation and prior attempts at fistula repair had been performed in 9 patients (34%) for benign (26) or malignant (3) uterine conditions. All patients were treated with the O'Conor technique 6 weeks to 48 months (median 8 weeks) after fistula diagnosis. RESULTS: The vesicovaginal fistula was successfully corrected in all patients at the first attempt and only 1 had stress urinary incontinence associated with urethral incompetence. No significant bladder dysfunction or decrease in bladder capacity was seen after repair. CONCLUSIONS: Considering the inferior clinical results of the transvaginal and transvesical approaches compared to the O'Conor technique for repair of supratrigonal vesicovaginal fistula, it would be unethical to conduct a randomized study to prove the superiority of the latter method. We suggest that the O'Conor technique be considered the gold standard surgical method of repair of supratrigonal vesicovaginal fistulas.
Authors: João Paulo Zambon; Nelson S S Batezini; Eduardo R S Pinto; Milton Skaff; Marcia E Girotti; Fernando G Almeida Journal: Int Urogynecol J Date: 2009-12-01 Impact factor: 2.894