A vesicovaginal fistula (VVF) 3 months post-total hysterectomy is being evaluated. Cystoscopy and examination under anaesthesia show a 1.5 cm supratrigonal fistula. The PREFERRED surgical repair approach is:

• A Immediate abdominal transperitoneal repair at diagnosis
• B Percutaneous nephrostomy followed by prolonged catheterisation for 6 months
• C Laser fulguration of the fistula tract
• D Transvaginal repair (Latzko or O'Connor colpocleisis-type for small fistulas) with tissue interposition ✓

Explanation

For post-hysterectomy VVF, after an adequate waiting period (3 months to allow oedema and inflammation to resolve), the transvaginal approach provides excellent cure rates (>90%) for supratrigonal fistulas and has lower morbidity than the transabdominal approach. The Latzko procedure is used for high vaginal/vault fistulas. Tissue interposition (Martius flap) is added when tissue quality is poor. Abdominal repair is preferred for large, complex, or ureterovesical fistulas. Laser fulguration is not effective for established fistulas.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.