A vesicovaginal fistula develops 14 days after an abdominal hysterectomy. The site is supratrigonal. The OPTIMAL timing and approach for repair is:

• A Immediate surgical repair within 72 hours of diagnosis
• B Permanent urinary diversion with ileal conduit
• C Catheter drainage alone for 6 weeks — most VVFs close spontaneously
• D Wait 3–6 months for tissue maturation and repair via transvaginal approach (Latzko's) ✓

Explanation

Post-hysterectomy VVF repair should be delayed 3–6 months to allow resolution of inflammation, edema, and tissue necrosis, ensuring healthy well-vascularized tissue for repair. Latzko's partial colpocleisis (transvaginal approach) is the operation of choice for supratrigonal post-hysterectomy VVFs with success rates >90%. Immediate repair within 72 hours is advocated only for intraoperatively recognized injuries. Most gynecological VVFs do not close spontaneously with catheter drainage alone (unlike some obstetric fistulas). Urinary diversion is a last resort.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.