VESICOVAGINAL FISTULA

SURGICAL MANAGEMENT

Abstract

Objective: To present the efficacy and complications of
vesicovaginal fistulae repair in our setting. Place and duration of the study: Surgical unit-III, Bolan Medical
Complex Hospital, Akram Hospital Zarghoon Road, Quetta and Uhad Charity Hospital Quetta from April 1999
to March 2003. Patients and methods: A total of 32 patients of vesicovaginal fistulae resulting from causes
other than malignancies and pelvic radiations were included in the study. Patients were divided in to two groups
on the basis of the site of the fistula and the method of repair. Group-I comprised of 18 patients who had type-
II and low type-I fistulae and were operated by vaginal approach while group-II consisted of 14 patients who
had type-III and high type-I fistulae and were operated by abdominal approach. Patients of both groups were
discharged to go home after 5-7 days postoperatively. Postoperative follow up was carried out at out door on
weekly basis for two months. Results: The cause of vesico-vaginal fistulae was obstetrical in 28 (87.5%) and
gynaecological (hysterectomy) in 4 (12.5%) patients. Trans-vaginal repair of fistula was successful in 16 (88.9%)
patients at first operation while in abdominal approach the cure rate was 100%. However preoperative bleeding
requiring blood transfusion occurred in 5 (35.7%) patients of group-II. Another one patient in this group
developed wound infection. Dysuria/urinary frequency and hematuria persisted for few days postoperatively
in some patients of both groups. Urinary stress incontinence was present postoperatively in 5(27.7%) and 3
(21.4%) patients of group-I and group-II respectively but it subsided in two months time in all except 2 (11.1%)
patients of group-I. Conclusion: Birth trauma is still a major cause of vesicovaginal fistula in our region.
Improvement in health services and socio-cultural status can help to reduce the incidence of this demoralizing
injury. Once occurred VVF, can successfully be repaired by strictly adhering to principles of; a tension free
repair, adequate blood supply, prevention of infection and adequate postoperative bladder drainage.