Vesicovaginal Fistula · Conservative vs Transvaginal vs Transabdominal Repair

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Size/timing + cause/location
   Fistula size/timing? Accessible location? Cause (obstetric/postsurgical/radiation)?
   • Small, new (<2–3 weeks) → Small new → indwelling catheter
   • Needs surgery, vaginally accessible (low/mid) → Vaginally accessible → transvaginal repair
   • High/near the ureteric orifices/multiple/complex → High/complex → transabdominal repair
   • Radiation/complex/recurrent → Radiation/recurrence → delayed + tissue flap
2. [End] Small new → indwelling catheter
   Small, new → indwelling catheter for continuous drainage 4–6 weeks as a conservative trial of healing (± anticholinergic to reduce bladder spasm); surgery if it does not heal.
3. [End] Vaginally accessible → transvaginal repair
   Vaginally accessible (low/mid) → transvaginal repair (Latzko etc.); timing: simple cases may be repaired early, heavily inflamed cases delayed ~3 months; multilayer tension-free closure.
4. [End] High/complex → transabdominal repair
   High/near the ureteric orifices/multiple/complex → transabdominal (transvesical O'Conor) repair; ureteric reimplantation if needed; omental flap interposition.
5. [End] Radiation/recurrence → delayed + tissue flap
   Radiation/complex/recurrent → delayed repair + healthy tissue flap interposition (Martius/omentum/gracilis); assess urinary diversion if needed.

Source guidelines & references

• Vesicovaginal fistula management (transvaginal Latzko / transabdominal O'Conor; tissue flap interposition)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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