From the Research
Surgical repair is the most effective treatment for a vesicovaginal fistula that develops after a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLHBSO), with a success rate of 85-95% for the first attempt, as reported in the most recent and highest quality study 1. The surgical approach can be vaginal, abdominal, or laparoscopic, and the choice of approach depends on the size and location of the fistula, as well as the patient's overall health and medical history.
- Before surgery, the patient should undergo cystoscopy and imaging studies, such as CT cystography 2, to precisely locate the fistula and assess the surrounding tissue.
- The optimal timing for repair is typically 3-6 months after the initial injury to allow inflammation to subside, during which time the patient should manage symptoms with absorbent pads, frequent perineal care, and barrier creams to prevent skin breakdown.
- Antibiotics are only needed if there's active infection, and the patient should be closely monitored for signs of infection or other complications.
- The fistula occurs because of inadvertent bladder injury during hysterectomy, tissue ischemia from excessive cautery, or postoperative infection causing tissue breakdown between the bladder and vagina, as described in earlier studies 3, 4.
- Recent studies have also highlighted the importance of imaging in the diagnosis and management of vesicovaginal fistulas, including the use of CT and MRI to visualize the fistula and surrounding tissue 5, 2.