Our Experience with Genitourinary Fistulae

Abstract

Introduction: Our objective was to analyze the incidence, etiopathology, diagnosis and therapeutic aspects of the genitourinary fistula in an Indian population. Methods: This is a retrospective analysis of the genitourinary fistulae repaired at the Department of Urology, Institute of Medical Sciences, Banaras Hindu University, between January 1990 and December 2006. The surgical approach varied in each patient. Interposition grafts or flaps were used as and when required. The main outcomes analyzed were the incidence, etiology, surgical approaches, accessory procedure required, need for tissue interposition, cure rate per repair and overall success rate. Results: Out of 558 cases, 403 were vesicovaginal, 84 ureterovaginal, 43 urethrovaginal and 28 vesicouterine fistulae. The most common etiology was obstructed labor (72.2%), followed by hysterectomy. The transvaginal route was preferred for repair wherever possible. The transabdominal route was adopted for the repair of supratrigonal vesicovaginal, ureterovaginal and vesicouterine fistulae and if bladder augmentation was required. Conservative management was successful in 1.9% of the vesicovaginal fistulae and in 8 cases of ureterovaginal fistula. The remaining cases were managed surgically with excellent results. Conclusion: Genitourinary fistulae are not life-threatening but are socially debilitating. Surgical repair provides the definitive cure, but expectant treatment can be tried in selective patients.

Genitourinary Fistula: An Indian Perspective

“…The tissues at the site of the repair should be healthy and non-infected, and a well-vascularised interposition flap should be used if required. Efforts must be made to minimize urinary tract injuries by doing sharp and accurate dissection, meticulous hemostasis, and adequate mobilization of the bladder from the uterus and ureter identification [14]. Longer operating times, surgical blood loss exceeding 1,000 ml, large uterine size, and bladder injury extending into the trigone increase the risk of development of fistulae [15].…”

Laparoscopic Vesicovaginal Fistula Repair with Limited Cystotomy: A Rewarding Treatment Option

“…In developing countries, although obstructed labor is the leading cause of urogenital fistula, iatrogenic injury during gynecologic surgeries still accounts for a major portion of urogenital fistulas [1,2]. One in every 1800 hysterectomies accounts for urogenital fistula [6].…”

“…Gynecologic surgery is the most common cause associated with it [1,2]. In developed countries, VVF mostly occurs due to iatrogenic injury secondary to gynecologic surgery, of which hysterectomy is the leading cause.…”

“…Recently reported rate of VVF during hysterectomy is 1 in 788 [3][4][5]. In developing countries, poor obstetric care is the leading cause of VVF [2,6]. The majority of low-lying VVF can be repaired through transvaginal route.…”

The AINU Technique for Laparoscopic Vesico-Vaginal Fistula Repair: A Preliminary Report

“…With the emergence of safe obstetric practices, the incidence of VVF secondary to obstructed labor and other obstetric complications are on a wane [1]. Most of the VVFs encountered today are seen after gynecological surgeries, most commonly after abdominal or vaginal hysterectomies.…”