A 45-year-old woman with a vesicovaginal fistula (VVF) following an uncomplicated total abdominal hysterectomy presents 10 days postoperatively with continuous urinary leakage. The fistula is 3 mm at the vault, confirmed on cystoscopy. What is the MOST appropriate timing and approach for surgical repair?
- A Catheter drainage for 4–6 weeks; if not healed, surgical repair at 3 months after initial injury ✓
- B Immediate surgical closure on diagnosis to prevent infection
- C Conservative management with bladder drainage indefinitely
- D Immediate cystoscopic fulguration of the fistula tract
Correct answer: A. Catheter drainage for 4–6 weeks; if not healed, surgical repair at 3 months after initial injury
Explanation
Post-hysterectomy VVF (suture-type fistula, not ischaemic) is traditionally managed by allowing resolution of oedema and tissue inflammation: catheter drainage for 4–6 weeks is maintained first (small fistulae may close spontaneously). If the fistula persists, surgical repair is deferred to 3 months from injury to allow adequate tissue quality for a tension-free layered repair (Latzko or layered transvaginal repair). Immediate repair risks closure failure due to friable, oedematous tissue in the acute phase.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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