Iatrogenic Etiology of Adult Vesicovaginal Fistula Postsurgical 8191 in developed countries

Vesicovaginal fistulas occur as a result of injury to the vesi-covaginal septum. Pelvic surgery is the most common cause of these fistulas in western countries, and hysterectomy is responsible for approximately 80% of all VVFs.5 The incidence varies with the approach to repair [1: 1000 transabdominal (TA), 0.2:1000 transvaginal (TV), and 2.2:1000 with laparoscopic].6 The most common site is superior to the trigone, corresponding to the vaginal cuff. Other gynecologic procedures account for 11%, including caesarean delivery and dilation and curettage. Incontinence surgery, formalin injections, and laparoscopy are less reported causes of VVF.7

Pelvic radiation for malignancy can lead to VVF formation even after many years. The resulting fibrosis with arteritis nodosa, and decreased blood supply leads to tissue necrosis, sloughing, and fistula formation.

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