fistula. During the repair, we felt that the tissues were easily dissectible, in comparison with our previous experience of fistula repairs. The reason for that could be attributed to the hormonal changes in pregnancy. A vesico-uterine fistula was reported antenatally by Kennedy et al. (1999) where a classical caesarean section was performed at 26 weeks together with excision of the fistulous tract. In our case the repair of the vesico-vaginal fistula was performed at 8 weeks followed by an uneventful pregnancy. The patient was delivered by lower-segment caesarean section at 38 weeks.In a recent review from Nigeria, the average time to presentation was more than 5 years and this may be determined by inadequate access to health care. The time from symptoms to presentation of our patient was 3 years and was identified during a teaching visit of the author to Yemen.The cure rates (closure from the first attempt) of the vesicovaginal fistulae vary from 60 -98% (Hilton, 1997; Clement and Hilton, 2001). In our case the patient experienced full continence after removal of the catheter. It would be interesting to know whether the cure rate in pregnancy is better.
ConclusionVesico-vaginal fistula can be repaired successfully in pregnancy. Furthermore, this repair could prevent the potential risk of miscarriage. Further research is needed to find out if repairing fistulae in pregnancy is associated with better outcome.