Is the fistula related to : childbirth? Hysterectomy or pelvic surgery? Was the pelvis ever radiated for cancer? e.g., cervical or endometrial cancer? These are important questions that can impace success. That said, there is an abdominal approach to the repair of the vesicovaginal fistula. It involves llifting the bladder off the vagina, and repairing the bladder in multiple layers, and then placing a piece of Omentum (vascular fatty tissue from around the intestine) under the repair, in order to keep it from recurring. There are many pelvic surgeons who are trained to do this, myself included. The success (even after a repeat) depends on the size of the fistula, the location (near to or far from the ureters), the vascularity of the bladder tissue and the repair technique. You are right, subsequent repairs have a lower success rate than the initial repair, In addition,radiated tissue (e.g after cancer radiation) probably has the lowest chances of long term success.
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