Vesicovaginal fistulas: a gynecological experience in 41 cases at a German pelvic floor center

PURPOSE: Etiology, diagnosis and management of vesicovaginal fistulas in women referred to the German pelvic floor center Tuebingen over a 9-year period of time were analyzed. METHODS: Records of 41 consecutive women suffering from vesicovaginal fistulas between February 2006 and February 2015 were reviewed retrospectively. RESULTS: In the German case series presented, the most common etiology of vesicovaginal fistulas was total abdominal hysterectomy. Other causes, in descending order of frequency, were abdominal radical hysterectomy, endometriosis surgery, total laparoscopical hysterectomy, vaginal hysterectomy, surgical treatment for ovarian cancer, radiotherapy, supracervical laparoscopic hysterectomy, surgery for genital malformation, cesarean section and forceps delivery. The transvaginal approach, for surgical fistula treatment, was primarily adopted whenever the primary or recurrent fistula was accessible vaginally because of its minimally invasive nature and low morbidity. The vesicovaginal fistula cure rate was 97.5 %. 36 out of 41 vesicovaginal fistulas were closed transvaginally. In one case, the postradiation vesicovaginal fistula could not be cured and the patient required urinary diversion. CONCLUSION: To avoid repeated surgeries, fistula management in specialized centers is advantageous.