Surgical management of simple Vesicovaginal fistulae

Abstract

Objective: Vesicovaginal fistula is a fairly common occurrence in our country because of poor availability of obstetric care. The purpose of this study is to review our results in the surgical management of VVF.Design: Prospective study. Place and duration of the study: The study was conducted in the department of urology, Federal Government Services Hospital (F.G.S.H.); Islamabad, from February 2002 to January 2004. Patients and Methods: Eleven patients were operated for vesicovaginal fistulae. Transvaginal repair was done in 8 (72.7%) patients while transabdominal repair was adopted in 3 (27.3%) patients only. Inclusion criteria: All patients presented with vesicovaginal fistulae only. Exclusion criteria: All patients presented with genitourinary fistulae other than VVFs. Results: The majority of fistulae (10 (90.9%)) were caused by ischaemic necrosis of bladder and vaginal walls resulting from obstructed labour. One (9.1x) patient developed VVF after hysterectomy due to some gynaecological problem. Surgical repair proved to be successful through transabdominal route in all 3 (100%) cases of VVFs while in 6 (75x) of 8 (100%) cases through transvaginal route. To describe an overall result, 9 (81.8%) vesicovaginal fistulae were successfully repaired at first attempt. Conclusion: Vesicovaginal fistulae can be best managed following basic surgical principles like adequate exposure, identification of structures, wide mobilization, tension free closure, good haemostasis and uninterrupted bladder drainage.