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Aims: To evaluate various prognostic factors which determine outcome after surgical repair of VVF. Methods: A retrospective analysis of the record of 640 patients which underwent surgical repair of VVF during a period from Jan 2006 to June 2011. Multivariate analysis of the record was done using SPSS-19 software determining odds ratio with 95% confidence interval. Results: 640 patients underwent surgical repair of VVF. Overall success rate was 87.2%. Multivariate analysis determined that recurrence of VVF was significantly related to multiplicity (5 fold recurrence risk), pre-operative size of VVF (3 fold risk), secondary repair (3 fold risk) and etiology of the fistula (2 fold risk). Interposition of flap and delayed reconstruction was related to successful surgical outcome. Age, parity, route of repair and location of fistula were not significant prognostic factors for recurrence. Conclusions: Successful surgical repair of VVF require careful evaluation of various factors including number, size, previous attempts to surgical repair and etiology of VVF. One should opt for transabdominal route with delayed reconstruction and interposition of flap if above mentioned factors are present.

Aim: This study aimed to determine the frequency of medical and psychological morbidity of patients with urogenital fi stulae. Methods: It was a descriptive study carried out at Liaquat University Hospital and Isra University Hospital, Hyderabad, Pakistan from 01/06/2007 to 30/06/2018, where 520 patients with urogenital fi stulae were managed. A pre-designed proforma was used to record the details about medical and psycho-social consequences. Data was analyzed, and results were described as frequency and percentages. Results: Among 16759 gynecological admissions, 520 (3.1%) were confi rmed cases of urinary fi stulae. Average age of patients was 31±2.8 years and average parity was 3±2.4. Regarding health consequences, all patients had major degree depression. Majority (88%) of the patients were malnourished. Severe excoriation of vulva and inner thighs was seen in 338 (65%) patients. Vaginal stenosis, vaginal and vesical calculi were other medical problems. Almost all (n= 511, 98%) patients were found to be socially isolated. 62% patients kept themselves restricted to home, with avoidance of family gatherings and travelling. Marital breakdown seen in 81% (n=241). 90% of patients quit their job. Majority of them suff ered social, verbal or physical abuse. Conclusions: Patients with urogenital fi stulae not only havesurgical morbidity, they also do suff er from signifi cant medical and psychosocial morbidity. There is a defi nite need to address these under-looked miseriesby a devoted fi stulae team working in collaboration with social workers, religious leaders and healthcare providers.

Aims: To analyze the frequency of medical and psychological morbidity of patients with urogenital fistulae. There are many complications related to childbirth and gynaecological surgeries. Urogenital fistula is one of the worst complications. The women suffer from significant medical and psychological morbidity. These issues need to be addressed at every forum. Methods:  A descriptive study was carried out at Liaquat University Hospital and Isra University Hospital Hyderabad Pakistan from 01/06/2007 to 30/06/2018.  520 patients with urogenital fistulae were managed. A pre-designed performa was used to record the details about medical and psycho-social consequences. Data was analyzed, results were described as frequency and percentage. Results:  During the study period 520 confirmed cases of urinary fistulae were managed. Regarding psychological health all (100%) patients had major degree depression. 511 (98%) patients were found socially isolated. 458 (88%) patients were malnourished. 338 (65%) had severe excoriation of vulva, bladder and vaginal calculi were present 25 (4.8%) patients. Majority of the patients were suffered  social, verbal and physical abuse. Conclusions: Patients with urogenital fistulae are not only having the surgical morbidity but they do suffer significant medical and social morbidity. There is a definite need to address these under looked miseries by a devoted fistulae team work in collaboration with social workers, religious leaders and healthcare providers to bring life back to these patients.