Vesicovaginal Fistula: Epidemiology, Diagnostics and Robotic Assisted Repair with Peritoneal Flap Inlay

  • Marco Randazzo
  • Christian Padevit
  • Hubert JohnEmail author


The Latin term for fistula is “pipe” or “tube” and means an extra-anatomic anastomosis between two hollow organs (or an hollow organ and the environment). A fistula between the lower urinary tract and the vagina is termed vesicovaginal (VVF) or vesicourethral fistula; in high income countries, both fistula are almost exclusively iatrogenic, but may also result from, malignancy, inflammation or appear as congenital fistula.


  1. 1.
    Hilton P. Vesico-vaginal fistula: new perspectives. Curr Opin Obstet Gynecol. 2001;13(5):513–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv. 1996;51(9):568–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Muleta M, et al. Obstetric fistula in rural Ethiopia. East Afr Med J. 2007;84(11):525–33.PubMedGoogle Scholar
  4. 4.
    Hilton P. Trends in the aetiology of urogenital fistula: a case of ‘retrogressive evolution’? Int Urogynecol J. 2016;27(6):831–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hilton P, Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years’ experience in southeast Nigeria. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(4):189–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Sotelo R, et al. Laparoscopic repair of vesicovaginal fistula. J Urol. 2005;173(5):1615–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Kurz M, Horstmann M, John H. Robot-assisted laparoscopic repair of high vesicovaginal fistulae with peritoneal flap inlay. Eur Urol. 2012;61(1):229–30.CrossRefPubMedGoogle Scholar
  8. 8.
    John H. Vesikovaginale Fistel: Rekonstruktive Techniken. Urol Urogynäkol. 2005;12:35–6.Google Scholar
  9. 9.
    John H. Therapie der vesikovaginalen Fistel in Westafrika und Europa. Urol Urogynäkol. 2016;18:16–8.Google Scholar
  10. 10.
    Barone MA, et al. Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial. Lancet. 2015;386(9988):56–62.CrossRefPubMedGoogle Scholar
  11. 11.
    Lawson JB. Tropical gynaecology. Birth-canal injuries. Proc R Soc Med. 1968;61(4):368–70.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Goh JT. A new classification for female genital tract fistula. Aust N Z J Obstet Gynaecol. 2004;44(6):502–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Waaldijk K. Surgical classification of obstetric fistulas. Int J Gynaecol Obstet. 1995;49(2):161–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Frajzyngier V, Ruminjo J, Barone MA. Factors influencing urinary fistula repair outcomes in developing countries: a systematic review. Am J Obstet Gynecol. 2012;207(4):248–58.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Zhou L, et al. Factors influencing repair outcomes of vesicovaginal fistula: a retrospective review of 139 procedures. Urol Int, Urol Int. 2017;99:22–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Ayed M, et al. Prognostic factors of recurrence after vesicovaginal fistula repair. Int J Urol. 2006;13(4):345–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Ockrim JL, et al. A tertiary experience of vesico-vaginal and urethro-vaginal fistula repair: factors predicting success. BJU Int. 2009;103(8):1122–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Barone MA, et al. Determinants of postoperative outcomes of female genital fistula repair surgery. Obstet Gynecol. 2012;120(3):524–31.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153(4):1110–2. discussion 1112-3CrossRefPubMedGoogle Scholar
  20. 20.
    Eilber KS, et al. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169(3):1033–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Nagraj HK, Kishore TA, Nagalaksmi S. Early laparoscopic repair for supratrigonal vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(7):759–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Raz S, et al. Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol. 1993;150(1):56–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: An update. Indian J Urol. 2007;23(2):187–91.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72(3 Pt 1):313–9.PubMedGoogle Scholar
  25. 25.
    Chibber PJ, Shah HN, Jain P. Laparoscopic O’Conor’s repair for vesico-vaginal and vesico-uterine fistulae. BJU Int. 2005;96(1):183–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Rizvi SJ, et al. Modified laparoscopic abdominal vesico-vaginal fistula repair—“Mini-O’Conor” vesicotomy. J Laparoendosc Adv Surg Tech A. 2010;20(1):13–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Nezhat CH, et al. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. 1994;83(5 Pt 2):899–901.PubMedGoogle Scholar
  28. 28.
    Abdel-Karim AM, et al. Laparoscopic transperitoneal extravesical repair of vesicovaginal fistula. Int Urogynecol J. 2011;22(6):693–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Gozen AS, et al. Transperitoneal laparoscopic repair of iatrogenic vesicovaginal fistulas: Heilbronn experience and review of the literature. J Endourol. 2009;23(3):475–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Miklos JR, Sobolewski C, Lucente V. Laparoscopic management of recurrent vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(2):116–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Otsuka RA, et al. Laparoscopic repair of vesicovaginal fistula. J Endourol. 2008;22(3):525–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Ou CS, et al. Laparoscopic repair of vesicovaginal fistula. J Laparoendosc Adv Surg Tech A. 2004;14(1):17–21.CrossRefPubMedGoogle Scholar
  33. 33.
    Porpiglia F, et al. Laparoscopic vesico-vaginal fistula repair: our experience and review of the literature. Surg Laparosc Endosc Percutan Tech. 2009;19(5):410–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Tiong HY, et al. Laparoscopic repair of vesicovaginal fistula. Int Urol Nephrol. 2007;39(4):1085–90.CrossRefPubMedGoogle Scholar
  35. 35.
    Wong C, Lam PN, Lucente VR. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2006;20(4):240–3; discussion 243.CrossRefPubMedGoogle Scholar
  36. 36.
    Hemal AK, Kumar R, Nabi G. Post-cesarean cervicovesical fistula: technique of laparoscopic repair. J Urol. 2001;165(4):1167–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Engel N, John H. Laparoscopic robot assisted vesico-vaginal fistula repair with peritoneal flap inlay. Eur Urol. (supplements) 2008;179(4):666.Google Scholar
  38. 38.
    Hemal AK, Kolla SB, Wadhwa P. Robotic reconstruction for recurrent supratrigonal vesicovaginal fistulas. J Urol. 2008;180(3):981–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Melamud O, et al. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. 2005;65(1):163–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Schimpf MO, et al. Vesicovaginal fistula repair without intentional cystotomy using the laparoscopic robotic approach: a case report. JSLS. 2007;11(3):378–80.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: case series of five patients. Urology. 2006;67(5):970–3.CrossRefPubMedGoogle Scholar
  42. 42.
    Kelly E, Wu MY, MacMillan JB. Robotic-assisted vesicovaginal fistula repair using an extravesical approach without interposition grafting. J Robot Surg, J Robot Surg. 2018;12(1):173–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Machen GL, et al. Robotic repair of vesicovaginal fistulas using fibrin sealant. Can J Urol. 2017;24(2):8740–3.PubMedGoogle Scholar
  44. 44.
    Bora GS, et al. Robot-assisted vesicovaginal fistula repair: a safe and feasible technique. Int Urogynecol J. 2017;28(6):957–62.CrossRefPubMedGoogle Scholar
  45. 45.
    Jairath A, et al. Robotic repair of vesicovaginal fistula - initial experience. Int Braz J Urol. 2016;42(1):168–9.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Agrawal V, et al. Robot-assisted laparoscopic repair of vesicovaginal fistula: a single-center experience. Urology. 2015;86(2):276–81.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Marco Randazzo
    • 1
  • Christian Padevit
    • 1
  • Hubert John
    • 1
    Email author
  1. 1.Department of UrologyKantonsspital WinterthurWinterthurSwitzerland

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