Surgical technique for vesicovaginal fistula repair using the transvaginal flap-fistula offset method
Year: 2026
Type: article
Study design: Case Report
Abstract: Vesicovaginal fistula (VVF) is the most common type of urogenital fistula. It is typically caused by iatrogenic injuries, such as those sustained during pelvic surgery. Transvaginal repair is considered the preferred approach due to its minimally-invasive nature. However, the traditional Latzko procedure or layered closure techniques often sacrifice an excessive amount of vaginal wall tissue, which can lead to postoperative vaginal shortening and dyspareunia. This study aimed to introduce a modified transvaginal flap-fistula offset repair technique. This technique utilizes offset suturing of anatomical layers, not only improving the fistula closure rate but also maximally preserving vaginal length and function. A 48-year-old patient who developed VVF following total hysterectomy successfully underwent this procedure, with the operative time of 45 minutes and an estimated intraoperative blood loss of 5 ml. The urinary catheter was removed 4 weeks postoperatively, and the patient experienced no leakage. At 3-month follow-up, cystoscopy showed complete closure of the fistula. Vaginal anatomical morphology and length recovered well, with no sexual dysfunction. The Female Sexual Function Index score improved from 6 points preoperatively to 27 postprocedure. The transvaginal flap-fistula repair using an offset method can construct a robust tissue barrier and help avoid overlapping suture lines. It is a safe, effective, and minimally-invasive option that maintains vaginal length.
Authors: Xing-Qi Wang, Yi-Ling Cui, Ling Li, Ji-Hong Shen
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,480
Award: G5008718629
OpenAlex ID: W7167806743