VESICO-VAGINAL FISTULAE;

REVIEW OF THE CAUSES, DIAGNOSIS AND TREATMENT

Abstract

Objectives: To review the causes, diagnosis and treatment of vesico-vaginal
fistulae in the department of Gynaecology& Obstetrics, and Urology Department Civil Hospital
Quetta. Background: Vesico-vaginal fistula is not life threatening medical disease, but the woman
face problems like demoralization, isolation, social boycott and even divorce. The etiology of
the condition has been changed over the years and in developed countries obstetrical fistula
are rare and they are usually result of gynecological surgeries or radiotherapy. In countries
like Pakistan the situation is different, here literacy rate is low, parity rate is high and medical
facilities are deficient. People manage delivery at home and usually multi parity. Urogenital fistula
surgery doesn’t require special or advance technology but needs experienced urogynecologist
with trained team and post operative care which can restore health, hope and sense of dignity
to women. Methods: A retrospective study of 60 patients with different types of vesico-vaginal
fistula werereviewed between January 2005 to December 2008. Patients were analyzed with
regard to age, parity, cause, diagnosis, mode of treatment and outcome. Patients were also
evaluated initially according to prognosis. Results: During the study of four year period 60
patients of vesico-vaginal fistulae were reviewed. Majority of the patients were belonging to
middle age group. In 48 patients repair was done through transvaginal route and 12 were
operated through transabdominal route. One Ca patient expired and in 4 patients recurrence
occurred. Conclusions: Iatrogenic vesico-vaginal fistulae are more common. Difficult and
complicated fistulae need experienced surgeon. Establishment of separate fistula surgery unit
is suggested to get desired results.