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Fistula Repair

Genitourinary fistula repair is organized by the two tracts involved (bladder–vagina, ureter–vagina, urethra–vagina, vesicouterine, rectovaginal, rectourethral, urethrocutaneous, urethroperineal) and by the surgical approach that accesses them best. The recurring decisions are route (transvaginal vs. transabdominal vs. transperineal vs. transanal vs. combined), timing (immediate vs. early vs. delayed), interposition flap need (none vs. Martius vs. gracilis vs. omentum), and whether a protective diversion is required. Because the technique sets are almost entirely distinct between the sexes, the Decision Framework and Treatment Database are split below.

General Principles​

  • Principles of Fistula RepairTract anatomy and approach selection, timing-of-repair, tension-free multilayer closure, non-overlapping suture lines, interposition flap indications (Martius / gracilis / omentum), concomitant diversion and stenting, radiation-bed considerations, and the legitimacy of permanent dual diversion in catastrophic pelvises.

Decision Framework & Treatment Database​

  • Female Fistula RepairVVF, ureterovaginal, urethrovaginal, vesicouterine (Youssef), rectovaginal, and obstetric fistulas. Decision matrices by fistula type plus a searchable database of conservative, transvaginal, transabdominal, tissue-interposition, and obstetric techniques.
  • Male Fistula RepairRectourethral, enterovesical / colovesical, urosymphyseal / puboprostatic, urethrocutaneous, urethroperineal, and radiation-induced anterior urinary fistulas. Decision matrices by fistula type plus a searchable database of perineal, transanal, transabdominal, and extirpative techniques.
  • Fistula Repair (All Patients)Pyeloenteric, nephropleural, ureterocolonic, colovesical / enterovesical, vesicocutaneous, post-kidney-transplant ureteral, and vascular-urinary (ureteroarterial) fistulas. Decision framework + searchable database of percutaneous, endoscopic, endovascular, and open-reconstructive techniques.