Surgical repair of vesicovaginal fistulae

Abstract

Objective: In developing nations the vesicovaginal fistulae (VVF) generally result from neglected obstructed labor or as a complication of pelvic surgery. The aim of this study was to share our experience in surgical management of vesicovaginal fistulae. Design: Prospective study. Place and Duration of Study: The study was conducted in Gynaecological Unit-II of Liaquat Medical College Hospital (LMCH), Hyderabad from June 1996 to June 1999. Subjects and Methods: Forty patients were treated for VVF. Surgical procedure adopted for VVF repair in 95% cases was simple dissection and suturing. Almost all fistulae (95%) were repaired through transvaginal route. Results: The mean age was 23 years (range 13-55). Mean parity was 5 (range 0-10). 55% of fistulae occurred during first labor. Thirty-six (90%) vesicovaginal fistulae were successfully corrected at first attempt, 2 (5%) were corrected at second attempt augmenting a success rate of 95%. Conclusion: VVF from obstructed labor or surgical trauma can be successfully managed by simple method of dissection and suturing preferably by vaginal route. The basic principles like adequate exposure, wide mobilization of vaginal flaps over the site of fistulae and tension-free closure are the keys to success.