Vesicovaginal fistula repair

Since vesicovaginal fistulae still occur in 0.5-1% of all genito-urinary operations, it is essential to know how best to prevent them, as well as to be able to eventually recognize them intraoperatively. Once a vesicovaginal fistula has developed, the repairing surgeon will be confronted with a variety of issues regarding the timing of repair, the management of the urinary incontinence while awaiting the definitive repair, and the type of operative approach, whether it be vaginal or abdominal. After devoting the first part of this chapter to expose some of these controversies, a series of more complex cases are discussed to illustrate part of the experience gained through the years in the management of vesicovaginal fistulae.