The American Urological Association's (AUA) recommendation is that "synthetic sling surgery is contraindicated in stress incontinent patients with a concurrent urethrovaginal fistula
, urethral erosion, intraoperative urethral injury and/or urethral diverticulum."[sup.4]
The only case of combined fistula (VVF with UVF) documented, was seen after caesarean hysterectomy and of urethrovaginal fistula, after TOT repair.
The only case of urethrovaginal fistula was treated with interpositional Martius flap.
Twenty nine (25.6%) patients had ureterovaginal fistula, 3 (2.6%) had vesicouterine fistula and 1 (0.88%) each with urethrovaginal fistula and combined fistula (vesicovaginal fistula along with ureterovaginal fistula).
Vesicovaginal fistula was seen in 69.9%, 25.7% were ureterovaginal fistula, 2.7% vesicouterine fistula and 0.88% each urethrovaginal fistula and combined fistula.
Primary vaginal calculi occur from vaginal pooling of urine due to a urethrovaginal fistula
, or in bedridden women due to neurogenic voiding dysfunction and other reasons (2-4).
repair with Martius labial fat pad graft.
Other contraindications include an atonic detrusor with an elevated postvoid residual, uncontrolled and severe detrusor instability, vesicoureteral reflux, vesico- or urethrovaginal fistula
, or a history of pelvic radiation.
(8) Transvaginal mesh slings should not be used in women with urethral diverticulum, urethrovaginal fistula
, urethral injury, or prior transvaginal mesh complication (such as pain or mesh erosion).