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The purpose of writing this manuscript is to awaken the affected women and the dealing gynaecologists to enable them suspect, think, detect and then manage the ongoing overlooked ultra-micro vesico-vaginal fistulas (VVFs). Detailed history, thorough examination, and specific investigations are required to know all the characteristics of such genito-urinary fistulas. Modalities of management of such ultra-micro genito-urinary fistulas do not merely depend upon the facilities available in the treating center but mainly on the experience and expertise of the treating surgeon and the characteristics of the fistulas, because there is no consensus of opinion about any one particular procedure suitable for all types of the VVFs in the presence of different characteristics of fistulas and the signs and symptomatology of the affected women. [ABSTRACT FROM AUTHOR]

Purpose: To draft guidelines for choosing an ideal water-proofing flap during surgical closure of simple and complex vesicovaginal fistulas (VVFs). Aims and objectives: To apprise the treating surgical team for choosing the best suitable single or a combination of two pedicled water-proofing flaps to re-enforce the closure site of vesico-vaginal fistulas (VVFs) to prevent recurrences. Materials and methods: This includes brief description of various water-proofing flaps to be planned depending upon characteristics of VVFs, surrounding tissues, the route chosen to approach the VVF, expertise of surgical team and the facilities available at the medical center and the co-existing morbidities. Conclusions: Selection of appropriate single or double water-proofing flaps for re-enforcement of the closed vesico-vaginal fistula ensures success against subsequent recurrence. [ABSTRACT FROM AUTHOR]