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Management of genitourinary fistula

Mellano, Erin M.; Tarnay, Christopher M.

Current Opinion in Obstetrics & Gynecology: October 2014 - Volume 26 - Issue 5 - p 415–423
doi: 10.1097/GCO.0000000000000095
UROGYNECOLOGY: Edited by Narender Bhatia

Purpose of review: To review current literature on the management of genitourinary fistulae, specifically, the techniques for diagnosis, timing to repair, surgical approach and recent advancements in surgical technique.

Recent findings: Recent advancement in minimally invasive surgery has prompted surgeons to perform fistula repairs with laparoscopic or robotic-assisted laparoscopic techniques. Whereas there is a role for transabdominal fistula closure, the majority of fistulae are still best approached via a transvaginal route.

Summary: Genitourinary fistulae from obstetric trauma have received increased attention and funding to treat and prevent this devastating condition in developing countries. Despite multiple classification systems, a standardized classification that accurately identifies predictors of successful repair is lacking. In industrialized nations, genitourinary fistulae are rare and are most frequently associated with pelvic surgery, pelvic radiation, cancer or trauma. Surgical techniques to repair these fistulae have shifted from transabdominal laparotomy to minimally invasive laparoscopic procedures. Vascularized tissue flaps can play an important role in successful closure of complex fistulae. Despite advancements in surgical technology, overarching principles of fistula closure remain. The majority of fistulae can be closed through a transvaginal approach, with a tension-free, watertight, multilayer closure.

Department of Obstetrics & Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California, USA

Correspondence to Christopher M. Tarnay, MD, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Box 951740, Los Angeles, CA 90095-1740, USA. Tel: +1 310 267 5918; fax: +1 310 794 6635; e-mail: ctarnay@mednet.ucla.edu

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins