Is percutaneous cystostomy always necessary in transvaginal repair of benign vesicovaginal fistulae?

Abstract

Purpose: To retrospectively evaluate benign, primary vesicovaginal fistulas (VVF), to determine the outcomes of using only a urethral catheter without cystostomy as a urinary diversion. Methods: Twenty-five women with VVF were treated between April 2008 and October 2014 and evaluated retrospectively. Only primary, benign fistulas were included in this study. Patients with a malignant etiology and/or prior irradiation were excluded, as they required a more complex repair. All included VVFs were treated without replacing a percutaneous cystostomy. All patients were called back on postoperative day 10 for urethral catheter removal. Cystography was not performed before catheter removal. Patients were followed in our clinic postoperatively for one year. Results: Twenty-five patients with VVF were treated using a transvaginal technique without percutaneous cystostomy. All patients, except for two, were discharged the day after surgery. There were no major complications, Clavien Class 2 or greater and no recurrent fistulas were detected. Conclusion: We used only a urethral catheter for 10 days postoperatively in transvaginal VVF repairs. The results show that transvaginal repair of benign VVFs only with urethral catheter is successful and cost effective. Cystography was not necessary before catheter removal.