Only in small, clean, nonmalignant VVFs can conservative treatment be tried. Prolonged continuous catheter drainage for 3 to 5 weeks is suggested. Additionally, anti-
cholinergic medication to relax the detrusor muscle and prevent spasms is used. Estrogen is used routinely in postmenopausal women to promote healing. In the last few years, we have been successful in managing small VVFs with cystoscopic fulguration with and without fibrin glue injection. The same principles of conservative management are followed after the procedure.
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