Transvesical Approach

The advantage of this approach is the avoidance of entering the peritoneal cavity. In this approach, the bladder is opened with a midline vertical incision. The VVF is located and the ureteral orifices are cannulated with stents. The fistulous tract is circumscribed carefully and excised. The bladder is mobilized away from the vagina. The bladder is closed in two layers and the omentum is brought down and fixed to the vagina. Suprapubic and Foley catheters are placed. Postoperative care is similar to that previously described.

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