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    Is percutaneous cystostomy always necessary in transvaginal repair of benign vesicovaginal fistulae?
    (E-Century Publishing Corp, 2016) Gedik, Abdullah; Deliktas, Hasan; Celik, Nurettin; Kayan, Devrim; Bircan, Mehmet Kamuran
    Purpose: To retrospectively evaluate benign, primary vesicovaginal fistulas (VVF), to determine the outcomes of using only a urethral catheter without cystostomy as a urinary diversion. Methods: Twenty-five women with VVF were treated between April 2008 and October 2014 and evaluated retrospectively. Only primary, benign fistulas were included in this study. Patients with a malignant etiology and/or prior irradiation were excluded, as they required a more complex repair. All included VVFs were treated without replacing a percutaneous cystostomy. All patients were called back on postoperative day 10 for urethral catheter removal. Cystography was not performed before catheter removal. Patients were followed in our clinic postoperatively for one year. Results: Twenty-five patients with VVF were treated using a transvaginal technique without percutaneous cystostomy. All patients, except for two, were discharged the day after surgery. There were no major complications, Clavien Class 2 or greater and no recurrent fistulas were detected. Conclusion: We used only a urethral catheter for 10 days postoperatively in transvaginal VVF repairs. The results show that transvaginal repair of benign VVFs only with urethral catheter is successful and cost effective. Cystography was not necessary before catheter removal.
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    Which Surgical Technique Should be Preferred to Repair Benign, Primary Vesicovaginal Fistulas?
    (Urol & Nephrol Res Ctr-Unrc, 2015) Gedik, Abdullah; Deliktas, Hasan; Celik, Nurettin; Kayan, Devrim; Bircan, Mehmet Kamuran
    Purpose: To evaluate and compare the outcomes of benign, primary vesicovaginal fistulas (VVFs) treated using the transabdominal transvesical technique and the transvaginal technique without tissue interposition. Materials and Methods: A total of 53 consecutive women with VVF who were treated between September 1999 and October 2014 were evaluated retrospectively. Patients with a malignant etiology and/or prior irradiation were excluded because they required a more complex repair. In the first group, the repair was performed using the transabdominal transvesical technique (n = 28). After one of our fellows had completed his urogynecology training, he began to perform the repairs using the transvaginal technique (n = 25). All included VVF patients were treated without a tissue interposition. Results: Vesicovaginal fistula repair was performed in 53 patients, with a mean age of 41.4 +/- 15.2 years. There was no significant difference in terms of the patients' age, fistula size, and the number of deliveries between the groups. All cases failed in terms of conservative management. The size of the fistulas ranged from 15 to 20 mm. The admission time was between 3 days and 21 years, and it was longer in less educated patients. The success rate was 96.4% (27/28) in the transabdominal transvesical group and 100% (25/25) in the transvaginal group (P = 1.00). The hospitalization period and complications were significantly reduced in the transvaginal group (P = .00 and P = .004, respectively). No patients converted from a transvaginal to a transabdominal repair. There was only one recurrence in the transabdominal transvesical group. The patients were followed up for 1 year. Conclusion: Transvaginal repair of benign, primary VVFs is more advantageous than transabdominal transvesical repair. There was a significant decrease in the hospitalization period and complications rates using the transvaginal technique without tissue interposition.