Postoperative Complications

The most significant complication of transvaginal bladder neck closure is postoperative vesicovaginal fistula. This may occur early or late in the healing period. Steps one can perform to prevent the development of fistulas include: 1) use of several layers of closure; 2) watertight closure; 3) positioning the bladder neck high in the retropubic space; 4) avoidance of postoperative bladder spasms with anticholinergics; 5) use of a Penrose drain; 6) use of a Martius flap when necessary. Bleeding and infection may require surgical drainage, but should be readily controlled perioperatively. If fistula formation occurs, then secondary repair may be performed after a prudent period of observation. Often a rotational flap may be required to assist in the closure. Alternatively, an abdominal approach may be used with interposition of an omental flap to cover the repair.

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