Management of Urethrovaginal Fistula

Urethrovaginal fistula (UVF) is an abnormal communication between the urethra and vagina. These fistulae are best approached vaginally. Using principles of fistula closure by avoiding distal obstruction, limiting overlap of suture lines, and maintaining tension-free closure, UVF repair is associated with a >90% success rate. In instances of poor tissue quality, local tissue flaps are used to ensure adequate and tension-free fistula closure, specifically a labial fat pad (Martius flap). Special considerations with UVF closure include postoperative de novo stress urinary incontinence in 33–52% of women. We recommend staging UVF and anti-incontinence surgeries; however, there is an ongoing debate among experts regarding staging versus performing concomitant UVF and anti-incontinence surgery.