Roberto Angioli1, Francesco Plotti1, Corrado Terranova1, Carlo De Cicco Nardone1, Roberto Montera1, Roberto Ricciardi1, Alessia Aloisi1, Daniela Luvero1, Giuseppe Scaletta1, Salvatore Lopez1, Stella Capriglione1, Andrea Miranda1
1Università Campus Bio-Medico di Roma

Vesicovaginal fistulae are a major problem and a distressing complication of gynecologic and obstetric procedures. They are usually of iatrogenic origin or caused by malignancy. With this work we describe the success rate reported in literature by treatment modality and the guidelines used at our teaching hospitals. In general, we prefer the vaginal approach. We recommend to wait 4–6 weeks to perform surgical treatment. The vaginal repair techniques can be categorized as to those that are modifications of the Latzko procedure or a layered closure with or without a Martius flap. The most frequently used abdominal approaches are the bivalve technique or the fistula excision. The reported successful rate varies between 70 and 100% in non-radiated patients, with similar results with vaginal or abdominal approach. Fistulas in radiated patients are less frequently repaired and the success rate varies between 40 and 100%. In this setting many surgeons prefer to perform a urinary diversion. In conclusion, the vaginal approach should be the preferred one. It is acceptable to repeat a vaginal repair even after a first vaginal approach failure. In the more individualized management of fistulas associated with radiation, the vaginal approach should still be considered.