Materiały źródłowe

• #1 Vaginal Fistula: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula

  Prolonged labor, trauma and pelvic surgeries can cause vaginal fistulas. These openings form when vaginal tissue dies, creating a hole between your vagina and organs in the urinary or digestive systems. A vaginal fistula is an abnormal connection or opening that develops between your vaginal wall and a nearby organ. Most often, they develop between your vagina and an organ in your urinary system or in your digestive system. They most often occur due to damage to your vaginal tissue from things like childbirth, surgery, injury or infection. A lack of blood supply to vaginal tissue causes the tissue to die or become damaged. A hole or fistula forms in the tissue where this damage occurs. These openings can develop in a few days or over several years. Causes of vaginal fistulas include: Prolonged labor during childbirth. Vaginal tears during childbirth or an episiotomy. Abdominal or pelvic surgery, including C-sections and hysterectomies. Cancer in your pelvic area, like cervical cancer or colorectal (colon) cancer. Inflammatory bowel diseases (IBD) like Crohns disease and ulcerative colitis. Colon infections like diverticulitis. Radiation therapy to the pelvic region. Trauma or injury. Surgical treatments for vaginal fistulas are highly successful. Most women experience a full recovery and no longer have symptoms.

• #2 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK535350/

  A fistula is an abnormal connection between 2 epithelial surfaces. This is a general definition that applies to most of the known fistula but not all of them. The general description differentiates fistulae from sinuses, abscesses, and other forms of luminal tracts or extra-luminal collections. Fistula connects two surfaces or lumens. It begins on the offending side and makes its way to an adjacent lumen or surface. It follows the easiest and shortest path to the adjacent organ. Recto-vaginal fistula starts from the rectum and extends to the vagina. This activity describes the pathophysiology, etiology, and presentation of rectovaginal fistula and highlights the role of the interprofessional team in its management. […] Like other fistulae, RVF is a result of a complication of an underlying disease, surgical procedure, or injury. A good understanding of the pathophysiological process helps to assess better, manage, and prevent fistulae. Loss of wall integrity with ongoing inflammatory, infectious, or neoplastic processes at the rectal or vaginal wall can lead to erosion to the adjacent tissue or organ and establish an abnormal fistulous connection. When the initial process is reversible or curable, such as diverticulitis, fistulae have a better chance to resolve.

• #3 Vaginal fistula: Types, symptoms, and causes

  https://www.medicalnewstoday.com/articles/vaginal-fistula

  A vaginal fistula is an opening that connects the vagina to another organ, such as the bladder, rectum, or bowel. They usually develop after tissue damage or trauma from childbirth, surgery, infections, cancer, or a chronic condition. […] A vaginal fistula is an opening or hole that forms between the vaginal wall and another organ to which it is not normally connected. In females, fistulas involving the genitals and surrounding organs are common. They may occur due to difficult childbirths, pelvic surgery, infections, inflammation, or cancer treatment in the pelvis or genital area. […] Vaginal fistulas develop after tissue damage. Common causes include trauma from a vaginal birth, such as vaginal tears, abdominal or pelvic surgeries, including hysterectomy and cesarean section, radiation therapy for gynecologic cancer, cancers in the pelvic area, including colon cancer, cervical cancer, and vaginal cancer, infections, chronic illnesses, such as Crohns disease and diverticulitis, and a foreign body in the vagina. […] Vaginal fistulas describe openings between the vagina and other organs, such as the rectum, bowel, and bladder, which are not normally present. These openings may occur due to pelvic surgery, childbirth, or radiation treatment for cancer.

• #4 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  1. PATHOPHYSIOLOGY TISSUE DAMAGE AND NECROSIS AFTER INJURY CAUSES INFLAMMATION PROCESS OF CELL REGENERATION BEGINS ANGIO-GENESIS STARTS FIRST FIBROBLASTS PROLIFERATE AND SUBSEQUENTLY SYNTHESIZE AND DEPOSIT EXTRACELLULAR MATRIX, PARTICULARLY COLLAGEN (FIBROSIS PHASE) COLLAGEN DEPOSITION PEAKS APPROXIMATELY 7 DAYS AFTER INJURY AND CONTINUES FOR SEVERAL WEEKS SUBSEQUENTLY SCAR FORMATION AND ORGANIZATION (REMODELLING) AUGMENTS WOUND STRENGTH ANY DISRUPTION IN THIS SEQUENCE EVENTUALLY MAY CREATE A FISTULA 1-3 WEEKS AFTER TISSUE INJURY IS MOST VULNERABLE TIME TO ALTERATION IN HEALING ENVIRONMENT AS HYPOXIA, ISCHEMIA, MALNUTRITION, RADIATION OR CHEMOTHERAPY. EDGES OF WOUND EPITHELIALIZE TO FORM CHRONIC FISTULOUS TRACT […] […] 11. Etio-pathogenesis In developing countries, most common (70 %) cause is obstetrical due to ischemia or trauma. Ischemia result from- Prolonged compression on the bladder base between fetal head and symphysis pubis in obstructed labor Ischemic necrosis infection sloughing fistula develops in 3-5 days of delivery. Traumatic- caused during instrumental vaginal delivery as forceps application or destructive operation (craniotomy) or may occur during cesarean or cesarean hysterectomy. […]

• #5 Vaginal Fistula: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula

  Prolonged labor, trauma and pelvic surgeries can cause vaginal fistulas. These openings form when vaginal tissue dies, creating a hole between your vagina and organs in the urinary or digestive systems. A vaginal fistula is an abnormal connection or opening that develops between your vaginal wall and a nearby organ. Most often, they develop between your vagina and an organ in your urinary system or in your digestive system. They most often occur due to damage to your vaginal tissue from things like childbirth, surgery, injury or infection. A lack of blood supply to vaginal tissue causes the tissue to die or become damaged. A hole or fistula forms in the tissue where this damage occurs. These openings can develop in a few days or over several years. Causes of vaginal fistulas include: Prolonged labor during childbirth. Vaginal tears during childbirth or an episiotomy. Abdominal or pelvic surgery, including C-sections and hysterectomies. Cancer in your pelvic area, like cervical cancer or colorectal (colon) cancer. Inflammatory bowel diseases (IBD) like Crohns disease and ulcerative colitis. Colon infections like diverticulitis. Radiation therapy to the pelvic region. Trauma or injury. Surgical treatments for vaginal fistulas are highly successful. Most women experience a full recovery and no longer have symptoms.

• #6 Vaginal Fistula: Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/womens/urogynecology/vaginal-fistula

  A vaginal fistula begins with a lack of blood supply to the vaginal tissue, which causes the tissue to weaken and die. The holes can take days or, in some cases, years to develop. The initial damage may be caused by traumatic injury, certain treatments, or disease in the area. […] Common causes of vaginal fistulas: […] A fistula begins with a lack of blood supply to the vaginal tissue, which causes the tissue to weaken and die. The holes can take days or, in some cases, years to develop. The initial damage may be caused by traumatic injury, certain treatments, or disease in the area.

• #7 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may include depression, infertility, and social isolation. […] The underlying mechanism is poor blood flow to the affected area for a prolonged period of time. […] Over the course of the three to five days of labor, the unborn child presses against the mother’s vagina very tightly, cutting off blood flow to the surrounding tissues between the vagina and the rectum and between the vagina and the bladder, causing the tissues to disintegrate and rot away. […] Obstetric fistulae can also be caused by poorly performed abortions, and pelvic fracture, cancer, or radiation therapy targeted at the pelvic area, inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis). Other potential causes for the development of obstetric fistulae are sexual abuse and rape, especially in conflict/postconflict areas, and other trauma, such as surgical trauma. […] In the developed world, such as the US, the primary cause of obstetric fistulae, particularly rectovaginal fistulae, is the use of episiotomy and forceps.

• #8 Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes | Scientific Reports

  https://www.nature.com/articles/s41598-024-82366-y

  A vesicovaginal fistula (VVF) is defined as a pathological anatomical junction between the dorsal bladder wall and the anterior vagina. The pathophysiological mechanism for this abnormal anatomic connection is a necrosis of both organ walls as a result of ischemia. […] The timing of VVF repair depends on its etiology, comorbidities, and the anticipated approach for fistula repair. The transvaginal approach is more suitable for early repair, is less invasive, and is associated with a 90% or higher success rate. […] To treat patients with vesicovaginal fistulas, we developed a surgical technique called modified transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). This method demonstrated positive efficacy and was successfully applied to male patients with urine incontinence. By enabling a thorough examination of the peritoneal cavity and providing continuous visual surveillance of the surrounding tissues, it would overcome the limitations of vaginal surgery.

• #9

  https://www.ics.org/committees/developingworld/publicawareness/obstetricfistulaanintroduction

  Obstetric fistula is a wholly preventable condition, provided that appropriate medical and obstetric facilities including emergency caesarean section are available. […] In developing countries, obstetric fistula is the result of prolonged or obstructed (blocked) labour, often lasting several days, when the unborn baby cannot pass through the pelvis. The pressure of the babys head for an abnormally long time on the blood vessels supplying the tissue of the vagina, bladder, urethra and rectum cuts off the supply of oxygen (ischaemia) and leads to the death of the affected tissue (necrosis). […] The immense number of obstetric fistulas occurring in developing countries is of great concern, particularly since they are preventable if the right facilities are in place. Since surgical repair is not always successful even in the very best hands, prevention is paramount.

• #10 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  Vaginal fistulas (VF) represent abnormal communications between the vagina and either the distal portion of the digestive system or the lower urinary tract, but lack an accepted classification and standardised terminology. […] The spectrum of causes encompasses congenital and developmental abnormalities, inflammatory diseases, infections, tumours, sexual and obstetric trauma, irradiation and post-surgical injuries. […] Regardless of the underlying disorder, all VF result in substantial morbidity and severely impair the patients quality of life. […] Entero-VF may involve the sigmoid colon (colo-VF), rectum (recto-VF) or anus (ano-VF). Their underlying causes and mechanisms are summarised in Table 1. […] In developing countries, VF are still common and almost invariably secondary to obstructed labour. Conversely, despite advancements in open and laparoscopic surgical techniques, in the Western world, over 90% of all urinary VF now develop as iatrogenic complications of irradiation or surgical injury to either distal ureter or bladder. […] The ideal cross-sectional techniques depend on the anatomic site and affected organ. With appropriate acquisition and focused interpretation, state-of-the art CT and MRI provide optimal visualisation of entero- and urinary VF that is crucial for correct therapeutic choice and surgical planning.

• #11 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  1. PATHOPHYSIOLOGY TISSUE DAMAGE AND NECROSIS AFTER INJURY CAUSES INFLAMMATION PROCESS OF CELL REGENERATION BEGINS ANGIO-GENESIS STARTS FIRST FIBROBLASTS PROLIFERATE AND SUBSEQUENTLY SYNTHESIZE AND DEPOSIT EXTRACELLULAR MATRIX, PARTICULARLY COLLAGEN (FIBROSIS PHASE) COLLAGEN DEPOSITION PEAKS APPROXIMATELY 7 DAYS AFTER INJURY AND CONTINUES FOR SEVERAL WEEKS SUBSEQUENTLY SCAR FORMATION AND ORGANIZATION (REMODELLING) AUGMENTS WOUND STRENGTH ANY DISRUPTION IN THIS SEQUENCE EVENTUALLY MAY CREATE A FISTULA 1-3 WEEKS AFTER TISSUE INJURY IS MOST VULNERABLE TIME TO ALTERATION IN HEALING ENVIRONMENT AS HYPOXIA, ISCHEMIA, MALNUTRITION, RADIATION OR CHEMOTHERAPY. EDGES OF WOUND EPITHELIALIZE TO FORM CHRONIC FISTULOUS TRACT […] […] 11. Etio-pathogenesis In developing countries, most common (70 %) cause is obstetrical due to ischemia or trauma. Ischemia result from- Prolonged compression on the bladder base between fetal head and symphysis pubis in obstructed labor Ischemic necrosis infection sloughing fistula develops in 3-5 days of delivery. Traumatic- caused during instrumental vaginal delivery as forceps application or destructive operation (craniotomy) or may occur during cesarean or cesarean hysterectomy. […]

• #12 Fistulas – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/fistulas/

  Pathophysiology: deficient anastomoses/sutures, improper healing following intervention (e.g., radiation), or trauma leakage of intestinal contents local infection abscess formation and/or erosion intestinal epithelial defect epithelial cells penetrating into deeper layers of the mucosa formation of a tube-like structure tube connecting to other organs or the body surface (fistula formation) […] Pathophysiology: fistula between bladder and bowel direct spread of intestinal bacteria to the bladder recurrent UTIs […] Pathophysiology: Prolonged compression of soft tissue between the maternal pelvic bones and fetal head maternal soft tissue pressure necrosis formation of fistulas.

• #13 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  1. PATHOPHYSIOLOGY TISSUE DAMAGE AND NECROSIS AFTER INJURY CAUSES INFLAMMATION PROCESS OF CELL REGENERATION BEGINS ANGIO-GENESIS STARTS FIRST FIBROBLASTS PROLIFERATE AND SUBSEQUENTLY SYNTHESIZE AND DEPOSIT EXTRACELLULAR MATRIX, PARTICULARLY COLLAGEN (FIBROSIS PHASE) COLLAGEN DEPOSITION PEAKS APPROXIMATELY 7 DAYS AFTER INJURY AND CONTINUES FOR SEVERAL WEEKS SUBSEQUENTLY SCAR FORMATION AND ORGANIZATION (REMODELLING) AUGMENTS WOUND STRENGTH ANY DISRUPTION IN THIS SEQUENCE EVENTUALLY MAY CREATE A FISTULA 1-3 WEEKS AFTER TISSUE INJURY IS MOST VULNERABLE TIME TO ALTERATION IN HEALING ENVIRONMENT AS HYPOXIA, ISCHEMIA, MALNUTRITION, RADIATION OR CHEMOTHERAPY. EDGES OF WOUND EPITHELIALIZE TO FORM CHRONIC FISTULOUS TRACT […] […] 11. Etio-pathogenesis In developing countries, most common (70 %) cause is obstetrical due to ischemia or trauma. Ischemia result from- Prolonged compression on the bladder base between fetal head and symphysis pubis in obstructed labor Ischemic necrosis infection sloughing fistula develops in 3-5 days of delivery. Traumatic- caused during instrumental vaginal delivery as forceps application or destructive operation (craniotomy) or may occur during cesarean or cesarean hysterectomy. […]

• #14 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193277-overview

  The use of radiation to treat pelvic malignancies may give rise to RVFs. Fistulas that occur during such therapy usually result from tumor regression. […] A variety of infectious conditions can produce RVF. The most common are perirectal abscess/fistula and diverticulitis. Less commonly, tuberculosis, lymphogranuloma venereum, and Bartholin gland abscess can cause RVFs.

• #15 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  1. PATHOPHYSIOLOGY TISSUE DAMAGE AND NECROSIS AFTER INJURY CAUSES INFLAMMATION PROCESS OF CELL REGENERATION BEGINS ANGIO-GENESIS STARTS FIRST FIBROBLASTS PROLIFERATE AND SUBSEQUENTLY SYNTHESIZE AND DEPOSIT EXTRACELLULAR MATRIX, PARTICULARLY COLLAGEN (FIBROSIS PHASE) COLLAGEN DEPOSITION PEAKS APPROXIMATELY 7 DAYS AFTER INJURY AND CONTINUES FOR SEVERAL WEEKS SUBSEQUENTLY SCAR FORMATION AND ORGANIZATION (REMODELLING) AUGMENTS WOUND STRENGTH ANY DISRUPTION IN THIS SEQUENCE EVENTUALLY MAY CREATE A FISTULA 1-3 WEEKS AFTER TISSUE INJURY IS MOST VULNERABLE TIME TO ALTERATION IN HEALING ENVIRONMENT AS HYPOXIA, ISCHEMIA, MALNUTRITION, RADIATION OR CHEMOTHERAPY. EDGES OF WOUND EPITHELIALIZE TO FORM CHRONIC FISTULOUS TRACT […] […] 11. Etio-pathogenesis In developing countries, most common (70 %) cause is obstetrical due to ischemia or trauma. Ischemia result from- Prolonged compression on the bladder base between fetal head and symphysis pubis in obstructed labor Ischemic necrosis infection sloughing fistula develops in 3-5 days of delivery. Traumatic- caused during instrumental vaginal delivery as forceps application or destructive operation (craniotomy) or may occur during cesarean or cesarean hysterectomy. […]

• #16 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  1. PATHOPHYSIOLOGY TISSUE DAMAGE AND NECROSIS AFTER INJURY CAUSES INFLAMMATION PROCESS OF CELL REGENERATION BEGINS ANGIO-GENESIS STARTS FIRST FIBROBLASTS PROLIFERATE AND SUBSEQUENTLY SYNTHESIZE AND DEPOSIT EXTRACELLULAR MATRIX, PARTICULARLY COLLAGEN (FIBROSIS PHASE) COLLAGEN DEPOSITION PEAKS APPROXIMATELY 7 DAYS AFTER INJURY AND CONTINUES FOR SEVERAL WEEKS SUBSEQUENTLY SCAR FORMATION AND ORGANIZATION (REMODELLING) AUGMENTS WOUND STRENGTH ANY DISRUPTION IN THIS SEQUENCE EVENTUALLY MAY CREATE A FISTULA 1-3 WEEKS AFTER TISSUE INJURY IS MOST VULNERABLE TIME TO ALTERATION IN HEALING ENVIRONMENT AS HYPOXIA, ISCHEMIA, MALNUTRITION, RADIATION OR CHEMOTHERAPY. EDGES OF WOUND EPITHELIALIZE TO FORM CHRONIC FISTULOUS TRACT […] […] 11. Etio-pathogenesis In developing countries, most common (70 %) cause is obstetrical due to ischemia or trauma. Ischemia result from- Prolonged compression on the bladder base between fetal head and symphysis pubis in obstructed labor Ischemic necrosis infection sloughing fistula develops in 3-5 days of delivery. Traumatic- caused during instrumental vaginal delivery as forceps application or destructive operation (craniotomy) or may occur during cesarean or cesarean hysterectomy. […]

• #17

  https://www.ics.org/committees/developingworld/publicawareness/obstetricfistulaanintroduction

  Obstetric fistula is a wholly preventable condition, provided that appropriate medical and obstetric facilities including emergency caesarean section are available. […] In developing countries, obstetric fistula is the result of prolonged or obstructed (blocked) labour, often lasting several days, when the unborn baby cannot pass through the pelvis. The pressure of the babys head for an abnormally long time on the blood vessels supplying the tissue of the vagina, bladder, urethra and rectum cuts off the supply of oxygen (ischaemia) and leads to the death of the affected tissue (necrosis). […] The immense number of obstetric fistulas occurring in developing countries is of great concern, particularly since they are preventable if the right facilities are in place. Since surgical repair is not always successful even in the very best hands, prevention is paramount.

• #18 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may include depression, infertility, and social isolation. […] The underlying mechanism is poor blood flow to the affected area for a prolonged period of time. […] Over the course of the three to five days of labor, the unborn child presses against the mother’s vagina very tightly, cutting off blood flow to the surrounding tissues between the vagina and the rectum and between the vagina and the bladder, causing the tissues to disintegrate and rot away. […] Obstetric fistulae can also be caused by poorly performed abortions, and pelvic fracture, cancer, or radiation therapy targeted at the pelvic area, inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis). Other potential causes for the development of obstetric fistulae are sexual abuse and rape, especially in conflict/postconflict areas, and other trauma, such as surgical trauma. […] In the developed world, such as the US, the primary cause of obstetric fistulae, particularly rectovaginal fistulae, is the use of episiotomy and forceps.

• #19 Vesicovaginal and Ureterovaginal Fistula: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/452934-overview

  Unrecognized bladder injury during a difficult hysterectomy or cesarean delivery may result in vesicovaginal fistula formation. Most vesicovaginal fistulae occur when dissection of the bladder during the mobilization of the bladder flap causes devascularization or an unrecognized tear of the posterior bladder wall. Alternatively, if the vaginal cuff suture was unknowingly incorporated into the bladder, this can result in tissue ischemia, necrosis, and subsequent fistula formation. […] The ureter may become injured during the dissection around the infundibulopelvic ligament or ligation of the uterine vessels. Unexpected pelvic hemorrhage may obscure the surgeon’s vision and result in ureteral injury that manifests as delayed ureterovaginal fistula. Uncommonly, this can also occur in the setting of an unrecognized duplicated ureter.

• #20 Vesicovaginal and Ureterovaginal Fistula: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/452934-overview

  Fistulae resulting from vaginal birth occur during difficult or prolonged labor. The head of the fetus compresses the trigone or the bladder neck against the anterior arch of the pubic symphysis. This may result in tissue ischemia, necrosis, and eventual fistula formation. Currently, this is rare in the United States; however, it remains common throughout much of the world.

• #21 Vesicovaginal and Ureterovaginal Fistula: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/452934-overview

  Unrecognized bladder injury during a difficult hysterectomy or cesarean delivery may result in vesicovaginal fistula formation. Most vesicovaginal fistulae occur when dissection of the bladder during the mobilization of the bladder flap causes devascularization or an unrecognized tear of the posterior bladder wall. Alternatively, if the vaginal cuff suture was unknowingly incorporated into the bladder, this can result in tissue ischemia, necrosis, and subsequent fistula formation. […] The ureter may become injured during the dissection around the infundibulopelvic ligament or ligation of the uterine vessels. Unexpected pelvic hemorrhage may obscure the surgeon’s vision and result in ureteral injury that manifests as delayed ureterovaginal fistula. Uncommonly, this can also occur in the setting of an unrecognized duplicated ureter.

• #22 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193277-overview

  The use of radiation to treat pelvic malignancies may give rise to RVFs. Fistulas that occur during such therapy usually result from tumor regression. […] A variety of infectious conditions can produce RVF. The most common are perirectal abscess/fistula and diverticulitis. Less commonly, tuberculosis, lymphogranuloma venereum, and Bartholin gland abscess can cause RVFs.

• #23

  https://link.springer.com/article/10.1007/BF01658140

  The radiation-induced vaginal fistula is an extremely difficult rehabilitative challenge to the surgeon. Historically there has been a sense of frustration about prospects for success with these defects and many patients have been managed by either permanent colostomy or permanent urinary diversion. This report reviews a personal experience of 25 radiation-induced vaginal fistulas in 22 patients utilizing the Martius bulbocavernosus-labial fat flap technique. Successful closure was accomplished in 84.2% of the rectovaginal fistulas and 50% of the vesicovaginal fistulas. Only 1 patient required a second surgical effort for successful closure. There was no surgical mortality and no significant surgical morbidity. No patient with a rectovaginal fistula closure required subsequent colostomy for stricture. These results, coupled with the relative simplicity of the procedure, allow us to recommend this technique as firstline therapy for these difficult management problems. The majority of patients will be rewarded with successful rehabilitation.

• #24 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  Vaginal fistulas (VF) represent abnormal communications between the vagina and either the distal portion of the digestive system or the lower urinary tract, but lack an accepted classification and standardised terminology. […] The spectrum of causes encompasses congenital and developmental abnormalities, inflammatory diseases, infections, tumours, sexual and obstetric trauma, irradiation and post-surgical injuries. […] Regardless of the underlying disorder, all VF result in substantial morbidity and severely impair the patients quality of life. […] Entero-VF may involve the sigmoid colon (colo-VF), rectum (recto-VF) or anus (ano-VF). Their underlying causes and mechanisms are summarised in Table 1. […] In developing countries, VF are still common and almost invariably secondary to obstructed labour. Conversely, despite advancements in open and laparoscopic surgical techniques, in the Western world, over 90% of all urinary VF now develop as iatrogenic complications of irradiation or surgical injury to either distal ureter or bladder. […] The ideal cross-sectional techniques depend on the anatomic site and affected organ. With appropriate acquisition and focused interpretation, state-of-the art CT and MRI provide optimal visualisation of entero- and urinary VF that is crucial for correct therapeutic choice and surgical planning.

• #25 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193277-overview

  Several traumatic mechanisms for the development of RVF exist. Perineal lacerations during childbirth, especially those due to episioproctotomy, predispose patients to RVFs. […] Failure to recognize and correctly repair perineal lacerations, or secondary infection of perineal lacerations, further increases the chance of RVF. Prolonged labor with pressure on the rectovaginal septum can produce necrosis and result in RVF. […] Vaginal or rectal operative procedures, especially those performed near the dentate line, may cause RVFs. Stapled hemorrhoidopexy, STARR (stapled transanal rectal resection), and TRANSTAR (transanal stapler-assisted resection) have been increasingly associated with RVFs. […] Crohn disease and, less often, ulcerative colitis have been associated with RVFs. The fistula may arise primarily or, more often, in relation to a perirectal abscess or fistula, manifesting as complicated perianal sepsis.

• #26 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193277-overview

  The use of radiation to treat pelvic malignancies may give rise to RVFs. Fistulas that occur during such therapy usually result from tumor regression. […] A variety of infectious conditions can produce RVF. The most common are perirectal abscess/fistula and diverticulitis. Less commonly, tuberculosis, lymphogranuloma venereum, and Bartholin gland abscess can cause RVFs.

• #27 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK535350/

  A fistula is an abnormal connection between 2 epithelial surfaces. This is a general definition that applies to most of the known fistula but not all of them. The general description differentiates fistulae from sinuses, abscesses, and other forms of luminal tracts or extra-luminal collections. Fistula connects two surfaces or lumens. It begins on the offending side and makes its way to an adjacent lumen or surface. It follows the easiest and shortest path to the adjacent organ. Recto-vaginal fistula starts from the rectum and extends to the vagina. This activity describes the pathophysiology, etiology, and presentation of rectovaginal fistula and highlights the role of the interprofessional team in its management. […] Like other fistulae, RVF is a result of a complication of an underlying disease, surgical procedure, or injury. A good understanding of the pathophysiological process helps to assess better, manage, and prevent fistulae. Loss of wall integrity with ongoing inflammatory, infectious, or neoplastic processes at the rectal or vaginal wall can lead to erosion to the adjacent tissue or organ and establish an abnormal fistulous connection. When the initial process is reversible or curable, such as diverticulitis, fistulae have a better chance to resolve.

• #28 Vaginal fistula – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/symptoms-causes/syc-20355762

  Vaginal fistulas can form after childbirth or after an injury, a surgery, an infection or radiation treatment. […] Surgery complications. Surgeries that involve the vaginal wall, anus or rectum can lead to vaginal fistulas. So can surgery on the area between the vagina and anus, called the perineum. Fistulas can form for reasons such as injuries during surgery and infections after surgery. […] Childbirth injuries. A vaginal fistula could stem from tearing that sometimes happens when a baby’s head comes through the opening of the vagina. Or a fistula might form due to an infection of a surgical cut made between the vagina and the anus to help deliver a baby. […] Certain cancers and radiation therapy. Cancer of the anus, rectum, vagina or cervix can lead to a vaginal fistula. So can damage from radiation therapy for the treatment of cancer in the pelvic area.

• #29 Colorectal-Vaginal Fistulas: Imaging and Novel Interventional Treatment Modalities

  https://www.mdpi.com/2077-0383/7/4/87

  Vaginal fistulas account for some of the most distressing symptoms seen by clinicians today. The etiology of vaginal fistulas includes obstetrical complications, inflammatory bowel disease, post-surgical causes, pelvic malignancies, trauma, infection, congenital conditions, and radiation effects. […] The prevalence of fistulas is poorly delineated in the literature, and varies widely in regards to etiology. Worldwide, the most common types of fistulas are vesicovaginal and rectovaginal due to obstetric causes. […] This is thought to be a result of tissue necrosis in the pelvis, caused by tissue entrapment between fetal parts and the bony pelvis. […] In industrialized countries, vaginal fistulas are more commonly iatrogenic, resulting from surgical intervention or radiation therapy. […] The most common iatrogenic cause is surgery following obstetric complications or gynecologic procedures, predominantly hysterectomies, with the most common type thought to be vesicovaginal fistulas.

• #30 Colorectal-Vaginal Fistulas: Imaging and Novel Interventional Treatment Modalities

  https://www.mdpi.com/2077-0383/7/4/87

  Vaginal fistulas account for some of the most distressing symptoms seen by clinicians today. The etiology of vaginal fistulas includes obstetrical complications, inflammatory bowel disease, post-surgical causes, pelvic malignancies, trauma, infection, congenital conditions, and radiation effects. […] The prevalence of fistulas is poorly delineated in the literature, and varies widely in regards to etiology. Worldwide, the most common types of fistulas are vesicovaginal and rectovaginal due to obstetric causes. […] This is thought to be a result of tissue necrosis in the pelvis, caused by tissue entrapment between fetal parts and the bony pelvis. […] In industrialized countries, vaginal fistulas are more commonly iatrogenic, resulting from surgical intervention or radiation therapy. […] The most common iatrogenic cause is surgery following obstetric complications or gynecologic procedures, predominantly hysterectomies, with the most common type thought to be vesicovaginal fistulas.

• #31 Colorectal-Vaginal Fistulas: Imaging and Novel Interventional Treatment Modalities

  https://www.mdpi.com/2077-0383/7/4/87

  Other risk factors include smoking, diabetes, obesity, and a previous history of irradiation. […] In the setting of pelvic malignancies, tumors may cause local tissue destruction resulting in fistula formation. […] Radiation can lead to fistula formation due to obliterative endarteritis and chronic ischemia. […] The accurate diagnosis of vaginal fistulas begins with a detailed history and careful physical examination of the patient. […] Currently, the preferable modalities of choice for pelvic fistula evaluation are magnetic resonance (MR) and multidetector computed tomography (CT) for patients unable to get an MRI, with the goal of imaging being to provide the clinician with a specific anatomic site and fistula course. […] Once diagnosis has been achieved, the management of patients with vaginal fistulas is as much determined by their etiology as by physical factors, including the size, location, and complexity of the tract.

• #32

  https://www.ics.org/committees/developingworld/publicawareness/obstetricfistulaanintroduction

  The primary risk factors for obstetric fistula are lack of access to medical facilities, obstetric care and emergency caesarean section delivery; lack of adequately trained, skilled medical staff; lack of medical supplies and equipment. […] Other contributory risk factors include poverty and malnutrition leading to stunted growth that could make women more susceptible to obstructed labour.

• #33 Surgeons’ perspectives for a future obstetric fistula classification system: exploring the key parameters | Published in Journal of Global Health Reports

  https://www.joghr.org/article/77981-surgeons-perspectives-for-a-future-obstetric-fistula-classification-system-exploring-the-key-parameters

  Obstetric fistulas are aberrant connections between the genital tract, urinary tract, or gastrointestinal tract. The etiology of obstetric fistulas in resource-limited settings is most commonly pressure necrosis secondary to prolonged obstructed labor related to reduced access to health services, home delivery, and lack of infrastructure. In contrast, obstetric fistulas in high-resource settings are much less common and are most often due to surgical complications. […] The most critical factors that surgeons found necessary to include in an updated fistula classification system are the bladder size, degree of fibrosis of the vagina, degree of urethral damage, location of the fistula, urethral length, and whether the fistula is circumferential or not. […] Given the inconsistency between what experienced and expert surgeons deem to be important determinants for the classification of obstetric fistula and what is currently included in classification systems, we call for constructing a new, validated classification system.

• #34 Vesicovaginal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/vesicovaginal-fistula-2?lang=us

  Vesicovaginal fistulas are abnormal fistulous connections between the urinary bladder and vagina, resulting in an involuntary discharge of urine through the vagina. […] The tract is lined by squamous epithelium at the vaginal end and transitional epithelium at the bladder end, often with focal ulceration and fibrosis. […] There are a number of causes, including prolonged obstructed labor (most common in developing countries), surgery, e.g. hysterectomy (most common in developed countries), pelvic malignancy (e.g. bladder carcinoma, endometrial carcinoma), radiotherapy, uterine rupture. […] Other risk factors include trauma, pelvic inflammatory disease and diabetes.

• #35 Vesicovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564389/

  Vesicovaginal fistula is an anomalous communication between the bladder and vagina, resulting in continuous urine leakage through the vagina. This condition occurs most commonly after obstetrical and gynecological injury. […] A vesicovaginal fistula is an abnormal communication between the bladder and vagina, resulting in continuous urine leakage through the vagina. This condition occurs most commonly after obstetrical and gynecological injury. In the developed world, the most common cause of vesicovaginal fistula is gynecological surgery. In North America, bladder injury during a hysterectomy is the most common cause. […] The etiology of this condition varies and can be categorized into congenital or acquired. Acquired vesicovaginal fistula can be further divided into obstetric surgical, malignant, radiation, and miscellaneous categories. Congenital vesicovaginal fistula is very rare and typically associated with other urogenital malformations. Vesicovaginal fistula occurs most commonly after obstetrical and gynecological injury. In the developed world, the most common cause of vesicovaginal fistula is gynecological surgery. In North America, bladder injury during a hysterectomy is the most common cause. In developing countries, obstructed labor and the resulting pressure necrosis are the most common causes of vesicovaginal fistulas.

• #36 Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes | Scientific Reports

  https://www.nature.com/articles/s41598-024-82366-y

  A vesicovaginal fistula (VVF) is defined as a pathological anatomical junction between the dorsal bladder wall and the anterior vagina. The pathophysiological mechanism for this abnormal anatomic connection is a necrosis of both organ walls as a result of ischemia. […] The timing of VVF repair depends on its etiology, comorbidities, and the anticipated approach for fistula repair. The transvaginal approach is more suitable for early repair, is less invasive, and is associated with a 90% or higher success rate. […] To treat patients with vesicovaginal fistulas, we developed a surgical technique called modified transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). This method demonstrated positive efficacy and was successfully applied to male patients with urine incontinence. By enabling a thorough examination of the peritoneal cavity and providing continuous visual surveillance of the surrounding tissues, it would overcome the limitations of vaginal surgery.

• #37 Vesicovaginal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/vesicovaginal-fistula-2?lang=us

  Vesicovaginal fistulas are abnormal fistulous connections between the urinary bladder and vagina, resulting in an involuntary discharge of urine through the vagina. […] The tract is lined by squamous epithelium at the vaginal end and transitional epithelium at the bladder end, often with focal ulceration and fibrosis. […] There are a number of causes, including prolonged obstructed labor (most common in developing countries), surgery, e.g. hysterectomy (most common in developed countries), pelvic malignancy (e.g. bladder carcinoma, endometrial carcinoma), radiotherapy, uterine rupture. […] Other risk factors include trauma, pelvic inflammatory disease and diabetes.

• #38 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK535350/

  A fistula is an abnormal connection between 2 epithelial surfaces. This is a general definition that applies to most of the known fistula but not all of them. The general description differentiates fistulae from sinuses, abscesses, and other forms of luminal tracts or extra-luminal collections. Fistula connects two surfaces or lumens. It begins on the offending side and makes its way to an adjacent lumen or surface. It follows the easiest and shortest path to the adjacent organ. Recto-vaginal fistula starts from the rectum and extends to the vagina. This activity describes the pathophysiology, etiology, and presentation of rectovaginal fistula and highlights the role of the interprofessional team in its management. […] Like other fistulae, RVF is a result of a complication of an underlying disease, surgical procedure, or injury. A good understanding of the pathophysiological process helps to assess better, manage, and prevent fistulae. Loss of wall integrity with ongoing inflammatory, infectious, or neoplastic processes at the rectal or vaginal wall can lead to erosion to the adjacent tissue or organ and establish an abnormal fistulous connection. When the initial process is reversible or curable, such as diverticulitis, fistulae have a better chance to resolve.

• #39 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193277-overview

  Several traumatic mechanisms for the development of RVF exist. Perineal lacerations during childbirth, especially those due to episioproctotomy, predispose patients to RVFs. […] Failure to recognize and correctly repair perineal lacerations, or secondary infection of perineal lacerations, further increases the chance of RVF. Prolonged labor with pressure on the rectovaginal septum can produce necrosis and result in RVF. […] Vaginal or rectal operative procedures, especially those performed near the dentate line, may cause RVFs. Stapled hemorrhoidopexy, STARR (stapled transanal rectal resection), and TRANSTAR (transanal stapler-assisted resection) have been increasingly associated with RVFs. […] Crohn disease and, less often, ulcerative colitis have been associated with RVFs. The fistula may arise primarily or, more often, in relation to a perirectal abscess or fistula, manifesting as complicated perianal sepsis.

• #40 Rectovaginal and anovaginal fistulas – UpToDate

  https://www.uptodate.com/contents/rectovaginal-and-anovaginal-fistulas

  Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in resource-limited countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. […] These fistulas can also occur following a failed repair of a third- or fourth-degree laceration of the perineum, from unrecognized injury at the time of vaginal delivery, and from episiotomy infection. Radiation damage and Crohn disease are two other important causes of RVFs. […] RVFs may also occur following difficult hysterectomies, especially those performed for severe endometriosis with involvement or obliteration of the posterior cul-de-sac (pouch of Douglas); from extension or rupture of perirectal, perianal, and, rarely, Bartholin’s abscesses; and from any surgical procedures involving the posterior vaginal wall, perineum, anus, or rectum. […] In older women, RVFs can occur as a result of diverticulitis, colon cancer, or fecal impaction. In addition, treatment options for pelvic organ prolapse such as pessaries and various mesh repair procedures have been associated with RVFs.

• #41 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  The majority of rectovaginal fistulas are caused by childbirth injury. Trauma related to operative vaginal deliveries such as forceps and vacuum deliveries, as well as third- and fourth-degree tears, increases the risk for rectovaginal fistulas to develop. […] Rectovaginal fistulas may involve disruption to the internal and external anal sphincter muscles. […] Irrespective of the approach, the fistula tract should be removed to allow normal tissue with a good blood supply to knit together. If the tissue near the fistula tract has poor blood supply, a graft or flap may be placed to promote healing. Grafts, or flaps, can come from a women’s own fat tissue or muscle that is placed over the repaired fistula tract. Other biologic grafts taken from animal tissue or human cadavers can also be used. The repair may also involve reconstruction of the internal and external anal sphincter muscles.

• #42 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  The majority of rectovaginal fistulas are caused by childbirth injury. Trauma related to operative vaginal deliveries such as forceps and vacuum deliveries, as well as third- and fourth-degree tears, increases the risk for rectovaginal fistulas to develop. […] Rectovaginal fistulas may involve disruption to the internal and external anal sphincter muscles. […] Irrespective of the approach, the fistula tract should be removed to allow normal tissue with a good blood supply to knit together. If the tissue near the fistula tract has poor blood supply, a graft or flap may be placed to promote healing. Grafts, or flaps, can come from a women’s own fat tissue or muscle that is placed over the repaired fistula tract. Other biologic grafts taken from animal tissue or human cadavers can also be used. The repair may also involve reconstruction of the internal and external anal sphincter muscles.

• #43 Ureterovaginal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ureterovaginal-fistula-2?lang=us

  Ureterovaginal fistulae refer to abnormal communications between the lumina of the ureter(s) and the vagina. […] Ureterovaginal fistulae are commonly a complication of hysterectomy. Other less common causes include pelvic trauma and radiation therapy of pelvic neoplasms. […] They are often coexistent with vesicovaginal fistulas, which have a similar presentation. It is important to recognize and distinguish between these fistulae in such settings, as their management differs considerably.

• #44 Vesicovaginal and Ureterovaginal Fistula: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/452934-overview

  Unrecognized bladder injury during a difficult hysterectomy or cesarean delivery may result in vesicovaginal fistula formation. Most vesicovaginal fistulae occur when dissection of the bladder during the mobilization of the bladder flap causes devascularization or an unrecognized tear of the posterior bladder wall. Alternatively, if the vaginal cuff suture was unknowingly incorporated into the bladder, this can result in tissue ischemia, necrosis, and subsequent fistula formation. […] The ureter may become injured during the dissection around the infundibulopelvic ligament or ligation of the uterine vessels. Unexpected pelvic hemorrhage may obscure the surgeon’s vision and result in ureteral injury that manifests as delayed ureterovaginal fistula. Uncommonly, this can also occur in the setting of an unrecognized duplicated ureter.

• #45 Ureterovaginal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ureterovaginal-fistula-2?lang=us

  Ureterovaginal fistulae refer to abnormal communications between the lumina of the ureter(s) and the vagina. […] Ureterovaginal fistulae are commonly a complication of hysterectomy. Other less common causes include pelvic trauma and radiation therapy of pelvic neoplasms. […] They are often coexistent with vesicovaginal fistulas, which have a similar presentation. It is important to recognize and distinguish between these fistulae in such settings, as their management differs considerably.

• #46 Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes | Scientific Reports

  https://www.nature.com/articles/s41598-024-82366-y

  By enabling thorough examination of the peritoneal cavity and ongoing visual control of the surrounding tissues, V-NOTES can get over the limitations of vaginal surgery. By utilizing the advantages of endoscopic surgery, the V-NOTES technique avoids the technical and surgical difficulties that come with traditional vaginal surgery. Furthermore, V-NOTES addresses problems associated with trocar-related complications and abdominal wall incisions by using low-cost, reusable, and handcrafted standard laparoscopic equipment. Fistulae healing in this way will have an 82-100% success rate.

• #47 James Marion Sims’s Treatment of Vesico-Vaginal Fistula | Embryo Project Encyclopedia

  https://embryo.asu.edu/pages/james-marion-simss-treatment-vesico-vaginal-fistula

  James Marion Sims developed a treatment for vesico-vaginal fistulas in Montgomery, Alabama in the 1840s. Vesico-vaginal fistulas consist of a breach of the wall separating the vagina and neighboring bladder, connecting the two cavities. The causes of vesico-vaginal fistulas are numerous, but many result from long, traumatic childbirth in which prolonged labor puts too much pressure on the vaginal wall. […] Tissue death, scar formation, and shedding of the vaginal walls can also occur in patients with vesico-vaginal fistulas. […] Inflammation, however, still regularly occurred when Sims used unsterilized silk to suture the wounds. […] Sims realized that he might use metal sutures as a possible substitute for silk ones. […] Silver’s aseptic and anti-inflammatory properties provided Sims with a wire stitch that held together the edges of fistulas without enabling infections. […] Sims’s application of metal sutures, specifically silver sutures, changed the way doctors treated vesico-vaginal fistulas.

• #48 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  13. Gynaecological causes are more common in developed countries. In post-operative cases, rate of fistula formation with procedure type and its indication, as highest chance with radical hysterectomy for cervical cancer and lowest with vaginal hysterectomy for prolapse. Risk factors include cancer stage, intra-operative bladder injury, diabetes and post-operative surgical site infection. Vaginal cancer shows a high likelihood of fistula formation (both vesicovaginal and rectovaginal) with no association with radiotherapy. […] […] 42. Surgical management Indication when conservative therapy fails or patient is not a candidate for conservative therapy. Principles of surgery- 1. Correct pre-operative assessment and preparation 2. Timely repair 3. Perfect asepsis and good exposure of fistula 4. Excision (minimal) of scar tissue at margins 5. Presence of healthy vascular margin 6. Mobilization of bladder wall from the vagina 7. Tension free repair in 2 layers 8. Fine suture material 9. Minimal use of electrocautery 10. Post-operative bladder drainage […]

• #49

  https://link.springer.com/article/10.1007/BF01658140

  The radiation-induced vaginal fistula is an extremely difficult rehabilitative challenge to the surgeon. Historically there has been a sense of frustration about prospects for success with these defects and many patients have been managed by either permanent colostomy or permanent urinary diversion. This report reviews a personal experience of 25 radiation-induced vaginal fistulas in 22 patients utilizing the Martius bulbocavernosus-labial fat flap technique. Successful closure was accomplished in 84.2% of the rectovaginal fistulas and 50% of the vesicovaginal fistulas. Only 1 patient required a second surgical effort for successful closure. There was no surgical mortality and no significant surgical morbidity. No patient with a rectovaginal fistula closure required subsequent colostomy for stricture. These results, coupled with the relative simplicity of the procedure, allow us to recommend this technique as firstline therapy for these difficult management problems. The majority of patients will be rewarded with successful rehabilitation.

• #50

  https://link.springer.com/article/10.1007/BF01658140

  The radiation-induced vaginal fistula is an extremely difficult rehabilitative challenge to the surgeon. Historically there has been a sense of frustration about prospects for success with these defects and many patients have been managed by either permanent colostomy or permanent urinary diversion. This report reviews a personal experience of 25 radiation-induced vaginal fistulas in 22 patients utilizing the Martius bulbocavernosus-labial fat flap technique. Successful closure was accomplished in 84.2% of the rectovaginal fistulas and 50% of the vesicovaginal fistulas. Only 1 patient required a second surgical effort for successful closure. There was no surgical mortality and no significant surgical morbidity. No patient with a rectovaginal fistula closure required subsequent colostomy for stricture. These results, coupled with the relative simplicity of the procedure, allow us to recommend this technique as firstline therapy for these difficult management problems. The majority of patients will be rewarded with successful rehabilitation.

• #51 Surgeons’ perspectives for a future obstetric fistula classification system: exploring the key parameters | Published in Journal of Global Health Reports

  https://www.joghr.org/article/77981-surgeons-perspectives-for-a-future-obstetric-fistula-classification-system-exploring-the-key-parameters

  Obstetric fistulas are aberrant connections between the genital tract, urinary tract, or gastrointestinal tract. The etiology of obstetric fistulas in resource-limited settings is most commonly pressure necrosis secondary to prolonged obstructed labor related to reduced access to health services, home delivery, and lack of infrastructure. In contrast, obstetric fistulas in high-resource settings are much less common and are most often due to surgical complications. […] The most critical factors that surgeons found necessary to include in an updated fistula classification system are the bladder size, degree of fibrosis of the vagina, degree of urethral damage, location of the fistula, urethral length, and whether the fistula is circumferential or not. […] Given the inconsistency between what experienced and expert surgeons deem to be important determinants for the classification of obstetric fistula and what is currently included in classification systems, we call for constructing a new, validated classification system.

• #52 Surgeons’ perspectives for a future obstetric fistula classification system: exploring the key parameters | Published in Journal of Global Health Reports

  https://www.joghr.org/article/77981-surgeons-perspectives-for-a-future-obstetric-fistula-classification-system-exploring-the-key-parameters

  Upon survey of experienced and expert fistula surgeons, the following factors were deemed as most important for a classification scheme: bladder size, degree of fibrosis of the vagina, degree of urethral damage, location of the fistula, urethral length, and whether the fistula is circumferential or not. […] This study, therefore, aims to assess which factors are the most important to include in a future classification scheme.

• #53 Laparoscopic Vesicovaginal Fistula Repair

  https://www.laparoscopyhospital.com/streamlecture/index.php?pid=44&p=&cat_id=&search=

  Overall, laparoscopic vesicovaginal fistula repair is a safe and effective option for treating this condition. […] It is important to note that not all vesicovaginal fistulas are amenable to laparoscopic repair, and the decision to use this approach will depend on the specific characteristics of the fistula and the experience of the surgeon. […] Patients should also be aware that there is a learning curve associated with laparoscopic vesicovaginal fistula repair, and the success of the procedure may depend on the experience and skill of the surgeon.

• #54

  https://www.ijsurgery.com/index.php/isj/article/view/3752

  Vesicovaginal Fistula (VVF), an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problems for the females. […] Failures in present study could be attributable to extensive fibrosis especially in prior failed repairs and in those with prolonged duration of symptoms. […] The principles of fistula repair, experience of surgeon and case selection remain important determinants of outcome.

• #55 Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-021-00147-9

  The success of a urinary fistula repair is defined based on successful closure and restoration of urinary continence. […] Stress incontinence occurs in about 10% of OF; it is associated with large fistula. […] The urethral involvement in obstetric fistula is a known risk factor for residual incontinence following fistula repair and one of the leading causes as demonstrated by previous studies. […] Factors which independently predict residual incontinence after repair include urethral involvement, small bladder, vaginal scarring and size of the fistula. […] The main complication documented in this study was residual incontinence despite successful closurestress incontinence.

• #56

  https://www.ijsurgery.com/index.php/isj/article/view/3752

  Vesicovaginal Fistula (VVF), an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problems for the females. […] Failures in present study could be attributable to extensive fibrosis especially in prior failed repairs and in those with prolonged duration of symptoms. […] The principles of fistula repair, experience of surgeon and case selection remain important determinants of outcome.

• #57 Vesicovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564389/

  The primary complication of vesicovaginal fistula surgery is recurrent fistula formation. Urinary frequency and urgency most commonly arise in the acute perioperative setting. Urgency and stress urinary incontinence are recognized as long-term complications of vesicovaginal repair. In obstetric causes for fistula formation where the sphincter mechanism is injured, stress urinary incontinence is common. […] The majority of vesicovaginal fistula require definitive surgical management; however, some can be successfully managed conservatively. Despite an optimistic prognosis for patients receiving proper treatment, efforts should be focused on the prevention of vesicovaginal formation.

• #58 Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-021-00147-9

  The success of a urinary fistula repair is defined based on successful closure and restoration of urinary continence. […] Stress incontinence occurs in about 10% of OF; it is associated with large fistula. […] The urethral involvement in obstetric fistula is a known risk factor for residual incontinence following fistula repair and one of the leading causes as demonstrated by previous studies. […] Factors which independently predict residual incontinence after repair include urethral involvement, small bladder, vaginal scarring and size of the fistula. […] The main complication documented in this study was residual incontinence despite successful closurestress incontinence.

• #59 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  13. Gynaecological causes are more common in developed countries. In post-operative cases, rate of fistula formation with procedure type and its indication, as highest chance with radical hysterectomy for cervical cancer and lowest with vaginal hysterectomy for prolapse. Risk factors include cancer stage, intra-operative bladder injury, diabetes and post-operative surgical site infection. Vaginal cancer shows a high likelihood of fistula formation (both vesicovaginal and rectovaginal) with no association with radiotherapy. […] […] 42. Surgical management Indication when conservative therapy fails or patient is not a candidate for conservative therapy. Principles of surgery- 1. Correct pre-operative assessment and preparation 2. Timely repair 3. Perfect asepsis and good exposure of fistula 4. Excision (minimal) of scar tissue at margins 5. Presence of healthy vascular margin 6. Mobilization of bladder wall from the vagina 7. Tension free repair in 2 layers 8. Fine suture material 9. Minimal use of electrocautery 10. Post-operative bladder drainage […]

• #60 Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-021-00147-9

  The success of a urinary fistula repair is defined based on successful closure and restoration of urinary continence. […] Stress incontinence occurs in about 10% of OF; it is associated with large fistula. […] The urethral involvement in obstetric fistula is a known risk factor for residual incontinence following fistula repair and one of the leading causes as demonstrated by previous studies. […] Factors which independently predict residual incontinence after repair include urethral involvement, small bladder, vaginal scarring and size of the fistula. […] The main complication documented in this study was residual incontinence despite successful closurestress incontinence.

• #61 Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-021-00147-9

  The success of a urinary fistula repair is defined based on successful closure and restoration of urinary continence. […] Stress incontinence occurs in about 10% of OF; it is associated with large fistula. […] The urethral involvement in obstetric fistula is a known risk factor for residual incontinence following fistula repair and one of the leading causes as demonstrated by previous studies. […] Factors which independently predict residual incontinence after repair include urethral involvement, small bladder, vaginal scarring and size of the fistula. […] The main complication documented in this study was residual incontinence despite successful closurestress incontinence.

• #62 Laparoscopic Vesicovaginal Fistula Repair

  https://www.laparoscopyhospital.com/streamlecture/index.php?pid=44&p=&cat_id=&search=

  Laparoscopic Vesicovaginal Fistula Repair is a minimally invasive surgical procedure used to repair a vesicovaginal fistula. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina, which can lead to the leakage of urine into the vagina. This can be a distressing condition for women, and can cause discomfort, embarrassment, and social isolation. […] The laparoscopic approach to repairing a vesicovaginal fistula involves the use of small incisions in the abdomen, through which a laparoscope (a thin, flexible tube with a camera and light at the end) and other surgical instruments are inserted. This allows the surgeon to visualize the area and perform the repair without making a large incision. […] The advantages of laparoscopic vesicovaginal fistula repair include a shorter hospital stay, reduced pain and scarring, and a quicker recovery time compared to traditional open surgery.

• #63 Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes | Scientific Reports

  https://www.nature.com/articles/s41598-024-82366-y

  A vesicovaginal fistula (VVF) is defined as a pathological anatomical junction between the dorsal bladder wall and the anterior vagina. The pathophysiological mechanism for this abnormal anatomic connection is a necrosis of both organ walls as a result of ischemia. […] The timing of VVF repair depends on its etiology, comorbidities, and the anticipated approach for fistula repair. The transvaginal approach is more suitable for early repair, is less invasive, and is associated with a 90% or higher success rate. […] To treat patients with vesicovaginal fistulas, we developed a surgical technique called modified transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). This method demonstrated positive efficacy and was successfully applied to male patients with urine incontinence. By enabling a thorough examination of the peritoneal cavity and providing continuous visual surveillance of the surrounding tissues, it would overcome the limitations of vaginal surgery.

• #64 Vaginal fistulas – Urogynecology & Pelvic Reconstructive Surgery | Northwell Health

  https://www.northwell.edu/obstetrics-and-gynecology/urogynecology-pelvic-reconstructive-surgery/conditions/vaginal-fistulas

  A vaginal fistula is an abnormal opening between the vagina and another organ. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina; a rectovaginal fistula is an abnormal opening between the rectum and the vagina; an enterovaginal fistula is an abnormal opening between the small bowels and the vagina. These openings may result in incontinence. […] The most common cause of vaginal fistulas is prolonged labor. Fistulas can also be caused by urologic or pelvic surgery, an infection or cancer. Sometimes, conditions like Crohns disease or diverticulitis can lead to a vaginal fistula. Accidents and traumatic injuries can also lead to a vaginal fistula. […] Vaginal fistulas are typically repaired surgically through the vagina. This procedure has the lowest risk of complication. However, depending on the location and complexity of the fistula, it may be necessary to perform the surgery through the abdomen. Repairing fistula through the abdomen can be done via robotic surgery, which typically minimizes the size of the incision and the amount of pain for the patient. […] If a patient presents with a clean fistula and is in good health, the success rate of fistula surgery is high. The procedure, like any surgery, does carry the risk of bleeding, infection and damage to surrounding organs.

• #65 Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes | Scientific Reports

  https://www.nature.com/articles/s41598-024-82366-y

  A vesicovaginal fistula (VVF) is defined as a pathological anatomical junction between the dorsal bladder wall and the anterior vagina. The pathophysiological mechanism for this abnormal anatomic connection is a necrosis of both organ walls as a result of ischemia. […] The timing of VVF repair depends on its etiology, comorbidities, and the anticipated approach for fistula repair. The transvaginal approach is more suitable for early repair, is less invasive, and is associated with a 90% or higher success rate. […] To treat patients with vesicovaginal fistulas, we developed a surgical technique called modified transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). This method demonstrated positive efficacy and was successfully applied to male patients with urine incontinence. By enabling a thorough examination of the peritoneal cavity and providing continuous visual surveillance of the surrounding tissues, it would overcome the limitations of vaginal surgery.

• #66 Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes | Scientific Reports

  https://www.nature.com/articles/s41598-024-82366-y

  By enabling thorough examination of the peritoneal cavity and ongoing visual control of the surrounding tissues, V-NOTES can get over the limitations of vaginal surgery. By utilizing the advantages of endoscopic surgery, the V-NOTES technique avoids the technical and surgical difficulties that come with traditional vaginal surgery. Furthermore, V-NOTES addresses problems associated with trocar-related complications and abdominal wall incisions by using low-cost, reusable, and handcrafted standard laparoscopic equipment. Fistulae healing in this way will have an 82-100% success rate.

• #67 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  46. Various routes of fistula repair 1. Abdominal 2. Vaginal 3. Trans-peritoneal 4. Trans-vesical 5. Laparoscopic Indication for Trans-peritoneal and Trans-vesical approaches- A. Fistula located high up and vagina is narrow B. Fistula close to ureteric openings C. Previous failed repair D. Large or complex fistula E. When an interposition graft is needed.

• #68 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  46. Various routes of fistula repair 1. Abdominal 2. Vaginal 3. Trans-peritoneal 4. Trans-vesical 5. Laparoscopic Indication for Trans-peritoneal and Trans-vesical approaches- A. Fistula located high up and vagina is narrow B. Fistula close to ureteric openings C. Previous failed repair D. Large or complex fistula E. When an interposition graft is needed.

• #69 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  46. Various routes of fistula repair 1. Abdominal 2. Vaginal 3. Trans-peritoneal 4. Trans-vesical 5. Laparoscopic Indication for Trans-peritoneal and Trans-vesical approaches- A. Fistula located high up and vagina is narrow B. Fistula close to ureteric openings C. Previous failed repair D. Large or complex fistula E. When an interposition graft is needed.

• #70 Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes | Scientific Reports

  https://www.nature.com/articles/s41598-024-82366-y

  By enabling thorough examination of the peritoneal cavity and ongoing visual control of the surrounding tissues, V-NOTES can get over the limitations of vaginal surgery. By utilizing the advantages of endoscopic surgery, the V-NOTES technique avoids the technical and surgical difficulties that come with traditional vaginal surgery. Furthermore, V-NOTES addresses problems associated with trocar-related complications and abdominal wall incisions by using low-cost, reusable, and handcrafted standard laparoscopic equipment. Fistulae healing in this way will have an 82-100% success rate.

• #71 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  13. Gynaecological causes are more common in developed countries. In post-operative cases, rate of fistula formation with procedure type and its indication, as highest chance with radical hysterectomy for cervical cancer and lowest with vaginal hysterectomy for prolapse. Risk factors include cancer stage, intra-operative bladder injury, diabetes and post-operative surgical site infection. Vaginal cancer shows a high likelihood of fistula formation (both vesicovaginal and rectovaginal) with no association with radiotherapy. […] […] 42. Surgical management Indication when conservative therapy fails or patient is not a candidate for conservative therapy. Principles of surgery- 1. Correct pre-operative assessment and preparation 2. Timely repair 3. Perfect asepsis and good exposure of fistula 4. Excision (minimal) of scar tissue at margins 5. Presence of healthy vascular margin 6. Mobilization of bladder wall from the vagina 7. Tension free repair in 2 layers 8. Fine suture material 9. Minimal use of electrocautery 10. Post-operative bladder drainage […]

• #72 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  The majority of rectovaginal fistulas are caused by childbirth injury. Trauma related to operative vaginal deliveries such as forceps and vacuum deliveries, as well as third- and fourth-degree tears, increases the risk for rectovaginal fistulas to develop. […] Rectovaginal fistulas may involve disruption to the internal and external anal sphincter muscles. […] Irrespective of the approach, the fistula tract should be removed to allow normal tissue with a good blood supply to knit together. If the tissue near the fistula tract has poor blood supply, a graft or flap may be placed to promote healing. Grafts, or flaps, can come from a women’s own fat tissue or muscle that is placed over the repaired fistula tract. Other biologic grafts taken from animal tissue or human cadavers can also be used. The repair may also involve reconstruction of the internal and external anal sphincter muscles.

• #73 Vesico vaginal fistula | PPT

  https://www.slideshare.net/slideshow/vesico-vaginal-fistula-242999654/242999654

  13. Gynaecological causes are more common in developed countries. In post-operative cases, rate of fistula formation with procedure type and its indication, as highest chance with radical hysterectomy for cervical cancer and lowest with vaginal hysterectomy for prolapse. Risk factors include cancer stage, intra-operative bladder injury, diabetes and post-operative surgical site infection. Vaginal cancer shows a high likelihood of fistula formation (both vesicovaginal and rectovaginal) with no association with radiotherapy. […] […] 42. Surgical management Indication when conservative therapy fails or patient is not a candidate for conservative therapy. Principles of surgery- 1. Correct pre-operative assessment and preparation 2. Timely repair 3. Perfect asepsis and good exposure of fistula 4. Excision (minimal) of scar tissue at margins 5. Presence of healthy vascular margin 6. Mobilization of bladder wall from the vagina 7. Tension free repair in 2 layers 8. Fine suture material 9. Minimal use of electrocautery 10. Post-operative bladder drainage […]

• #74 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  The majority of rectovaginal fistulas are caused by childbirth injury. Trauma related to operative vaginal deliveries such as forceps and vacuum deliveries, as well as third- and fourth-degree tears, increases the risk for rectovaginal fistulas to develop. […] Rectovaginal fistulas may involve disruption to the internal and external anal sphincter muscles. […] Irrespective of the approach, the fistula tract should be removed to allow normal tissue with a good blood supply to knit together. If the tissue near the fistula tract has poor blood supply, a graft or flap may be placed to promote healing. Grafts, or flaps, can come from a women’s own fat tissue or muscle that is placed over the repaired fistula tract. Other biologic grafts taken from animal tissue or human cadavers can also be used. The repair may also involve reconstruction of the internal and external anal sphincter muscles.

• #75 Vaginal Fistula: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula

  Prolonged labor, trauma and pelvic surgeries can cause vaginal fistulas. These openings form when vaginal tissue dies, creating a hole between your vagina and organs in the urinary or digestive systems. A vaginal fistula is an abnormal connection or opening that develops between your vaginal wall and a nearby organ. Most often, they develop between your vagina and an organ in your urinary system or in your digestive system. They most often occur due to damage to your vaginal tissue from things like childbirth, surgery, injury or infection. A lack of blood supply to vaginal tissue causes the tissue to die or become damaged. A hole or fistula forms in the tissue where this damage occurs. These openings can develop in a few days or over several years. Causes of vaginal fistulas include: Prolonged labor during childbirth. Vaginal tears during childbirth or an episiotomy. Abdominal or pelvic surgery, including C-sections and hysterectomies. Cancer in your pelvic area, like cervical cancer or colorectal (colon) cancer. Inflammatory bowel diseases (IBD) like Crohns disease and ulcerative colitis. Colon infections like diverticulitis. Radiation therapy to the pelvic region. Trauma or injury. Surgical treatments for vaginal fistulas are highly successful. Most women experience a full recovery and no longer have symptoms.

• #76 Vesicovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564389/

  Vesicovaginal fistula is an anomalous communication between the bladder and vagina, resulting in continuous urine leakage through the vagina. This condition occurs most commonly after obstetrical and gynecological injury. […] A vesicovaginal fistula is an abnormal communication between the bladder and vagina, resulting in continuous urine leakage through the vagina. This condition occurs most commonly after obstetrical and gynecological injury. In the developed world, the most common cause of vesicovaginal fistula is gynecological surgery. In North America, bladder injury during a hysterectomy is the most common cause. […] The etiology of this condition varies and can be categorized into congenital or acquired. Acquired vesicovaginal fistula can be further divided into obstetric surgical, malignant, radiation, and miscellaneous categories. Congenital vesicovaginal fistula is very rare and typically associated with other urogenital malformations. Vesicovaginal fistula occurs most commonly after obstetrical and gynecological injury. In the developed world, the most common cause of vesicovaginal fistula is gynecological surgery. In North America, bladder injury during a hysterectomy is the most common cause. In developing countries, obstructed labor and the resulting pressure necrosis are the most common causes of vesicovaginal fistulas.

• #77 Vaginal Fistula – Symptoms, Causes, Diagnosis and Treatment | CK Birla Hospital

  https://www.ckbhospital.com/blogs/vaginal-fistula-causes-symptoms-treatment/

  A fistula is defined as an unusual opening that develops between two organs of the body. A vaginal fistula is a tunnel-like opening that develops in the vagina wall. […] The vaginal fistula can lead to an abnormal interchange of fluids, gases, and substances between organs of different systems and the vagina. It can cause urine, gas, or stools to enter the vagina. […] A fistula in women is usually caused by tissue damage or inflammation. Traumatic vaginal fistulas occur due to damage to the tissue walls of the intestine, the urinary tract, or the vagina. This can happen due to surgical procedures/operations or prolonged labor during childbirth. […] An inflammatory fistula in women can form due to abscesses or cysts in the vagina or other traumas arising from disease or infection such as a tumor disease or inflammatory bowel disease like Crohns disease. […] Vaginal fistulas are caused by tissue damage to the vaginal walls. The kind of vaginal fistula depends on the organs involved. The treatment may involve surgery of the affected organs. You may also be prescribed medications or system-focused treatment based on what is causing the tissue damage.

• #78 Colorectal-Vaginal Fistulas: Imaging and Novel Interventional Treatment Modalities

  https://www.mdpi.com/2077-0383/7/4/87

  Other risk factors include smoking, diabetes, obesity, and a previous history of irradiation. […] In the setting of pelvic malignancies, tumors may cause local tissue destruction resulting in fistula formation. […] Radiation can lead to fistula formation due to obliterative endarteritis and chronic ischemia. […] The accurate diagnosis of vaginal fistulas begins with a detailed history and careful physical examination of the patient. […] Currently, the preferable modalities of choice for pelvic fistula evaluation are magnetic resonance (MR) and multidetector computed tomography (CT) for patients unable to get an MRI, with the goal of imaging being to provide the clinician with a specific anatomic site and fistula course. […] Once diagnosis has been achieved, the management of patients with vaginal fistulas is as much determined by their etiology as by physical factors, including the size, location, and complexity of the tract.

• #79 Vesicovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564389/

  The primary complication of vesicovaginal fistula surgery is recurrent fistula formation. Urinary frequency and urgency most commonly arise in the acute perioperative setting. Urgency and stress urinary incontinence are recognized as long-term complications of vesicovaginal repair. In obstetric causes for fistula formation where the sphincter mechanism is injured, stress urinary incontinence is common. […] The majority of vesicovaginal fistula require definitive surgical management; however, some can be successfully managed conservatively. Despite an optimistic prognosis for patients receiving proper treatment, efforts should be focused on the prevention of vesicovaginal formation.

• #80 Vaginal fistulas – Urogynecology & Pelvic Reconstructive Surgery | Northwell Health

  https://www.northwell.edu/obstetrics-and-gynecology/urogynecology-pelvic-reconstructive-surgery/conditions/vaginal-fistulas

  A vaginal fistula is an abnormal opening between the vagina and another organ. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina; a rectovaginal fistula is an abnormal opening between the rectum and the vagina; an enterovaginal fistula is an abnormal opening between the small bowels and the vagina. These openings may result in incontinence. […] The most common cause of vaginal fistulas is prolonged labor. Fistulas can also be caused by urologic or pelvic surgery, an infection or cancer. Sometimes, conditions like Crohns disease or diverticulitis can lead to a vaginal fistula. Accidents and traumatic injuries can also lead to a vaginal fistula. […] Vaginal fistulas are typically repaired surgically through the vagina. This procedure has the lowest risk of complication. However, depending on the location and complexity of the fistula, it may be necessary to perform the surgery through the abdomen. Repairing fistula through the abdomen can be done via robotic surgery, which typically minimizes the size of the incision and the amount of pain for the patient. […] If a patient presents with a clean fistula and is in good health, the success rate of fistula surgery is high. The procedure, like any surgery, does carry the risk of bleeding, infection and damage to surrounding organs.

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