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Vesicocutaneous Fistula — Management

Treatment is individualized based on etiology, defect size, and tissue quality. See clinical page: Vesicocutaneous Fistula.

Conservative Management​

Prolonged Foley catheter drainage to decompress the bladder may allow small fistulas to close spontaneously.

Vacuum-Assisted Closure (VAC)​

VAC has been used successfully as both definitive therapy and as a bridge to surgical repair, controlling urine exposure and promoting granulation tissue.[1][2]

Surgical Repair​

Fistulectomy with partial cystectomy is the standard for persistent fistulas. Large defects require multilayer closure with interposition of vascularized tissue — pedicled options include the rectus femoris musculocutaneous flap and the omental flap — to ensure successful healing.[3][4][2]

Endoscopic Suture Cystorrhaphy​

Transurethral suture cystorrhaphy has been described as a minimally invasive alternative in selected patients.[5]

References​

1. Elizondo RA, Au JK, Gargollo PC, Tu DT. Vacuum-assisted closure of a vesicocutaneous fistula in a pediatric patient after bladder cystoplasty. Urology. 2016;95:190–1. doi:10.1016/j.urology.2016.04.001

2. Katsuragi Y, Ueda K, Kajikawa A, Tateshita T, Okochi H. Repair of a huge vesicocutaneous fistula with the rectus femoris musculocutaneous flap and VAC. J Wound Care. 2010;19(4):157–9. doi:10.12968/jowc.2010.19.4.157

3. Kosaka T, Asano T, Azuma R, et al. A case of vesicocutaneous fistula to the thigh. Urology. 2009;73(4):929.e7–8. doi:10.1016/j.urology.2008.04.063

4. Bockrath JM, Nanninga JB, Lewis VL, Grayhack JT. Extensive suprapubic vesicocutaneous fistula following trauma. J Urol. 1981;125(2):246–8. doi:10.1016/s0022-5347(17)54989-7

5. McKay HA. Vesicovaginal and vesicocutaneous fistulas: transurethral suture cystorrhaphy as a new closure technique. J Urol. 1997;158(4):1513–6. doi:10.1016/s0022-5347(01)64256-3