A 35-year-old woman develops a vesicovaginal fistula (VVF) 14 days after total abdominal hysterectomy for fibroids. She presents with continuous painless urinary incontinence. The optimal timing of surgical repair is:

• A 3 months after diagnosis once oedema and inflammation have resolved ✓
• B Immediate repair within 48 hours of diagnosis
• C 6 months after initial surgery in all cases to allow maximum tissue healing
• D 12 months for post-radiation VVF, 3 months for post-surgical VVF

Explanation

The traditional principle for VVF repair after surgical injury (non-radiation, non-obstetric) is to wait 3 months for inflammatory oedema to subside and tissues to become well-vascularised and supple, which maximises surgical success rates (primary closure success ~90%). Immediate repair (within 48 hours) is feasible only if the fistula is recognised intraoperatively before tissue reaction develops. Post-radiation VVF requires waiting 12–18 months, not 6 months. The 3-month wait applies specifically to post-surgical injury VVF; some modern evidence supports earlier repair (6 weeks) in uninfected fistulas.

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

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Written and medically reviewed by the StethoPrep medical team.