Combined Vaginal and Transvesical Approach in Successful Repair of Vesicovaginal Fistula

The distressing problem of urinary leakage through a vesicovaginal fistula has been much discussed and numerous techniques have been presented for surgical repair. Unfortunately, many of these methods and special "tricks," ranging from Sims' introduction of silver wire sutures to the more recent partial colpocleisis (Latzko), are subject to failure and only lead to greater difficulties at attempted secondary repair. The gynecologist has uniformly attacked closure of the fistula by the vaginal route and has shied away from the transvesical approach, while the urologist has reversed this and has tried to cure this abnormal opening only through a suprapubic opening. Moir states: "Don't attempt a transvesical or transabdominal operation unless for a very special reason." Similarly, Falk writes: "Suprapubic, extraperitoneal and transvesical and transabdominal procedures are now seldom performed by gynecologists." Also (ibid.), "These transvesical methods of repair are still the ones most frequently used by urologists." The separate specialist