A vesicovaginal fistula is confirmed in a 30-year-old woman 14 days after total abdominal hysterectomy. The fistula is 5 mm on cystoscopy and she has continuous urinary incontinence. Initial conservative management includes:

• A Immediate transabdominal repair with omental interposition
• B Prolonged urethral catheterisation for 4–6 weeks ✓
• C Vaginal repair (Latzko's colpocleisis) within 48 hours
• D Urinary diversion via ileal conduit

Explanation

Small post-operative VVFs (< 1 cm) identified early may close spontaneously with prolonged continuous catheterisation (4–6 weeks), especially if there is no tissue necrosis. This is the first-line conservative approach. Surgical repair (vaginal or abdominal) is preferred after 3–6 months to allow tissue oedema and inflammation to resolve. Immediate repair (within 48 hours) is only appropriate for intraoperatively recognised fistulas.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.