Modified vaginal surgical technique for the management of the lateral vesico-vaginal fistulae

Obstetric fistulae vary significantly in size, location and condition of surrounding tissues. Traditional description of a genito-urinary fistula repair involves a fistula located in the midline of the vaginal wall, with minimal scarring or adhesions of the bladder/urethra to the surrounding vagina or pubic bone. Obstetric fistulae are often associated with significant scarring, situated laterally with adhesions to the pubic bone. This increases the difficulty in mobilising the bladder and in securing the lateral angles of the fistula during surgery. This paper describes a method to improve access to the laterally situated fistulae and thus facilitate surgical closure.