Vesicovaginal Fistula : A New Treatment Modality

Abstract

umbilical and one supra pubic scar marks. Liver and spleen were not palpable. Per speculum examination revealed that the vagina and vault were wet with urine. A 0.5 x 0.5 cm fistula was visualized at the vault in the center. On per vaginal examination the vault was supple with no palpable mass. On investigation, complete haemogram, urine routine examination, serum electrolytes, renal function tests, ultrasound (abdomen and pelvis) were within normal limits. A three-swab test done confirmed the fistula to be vesicovaginal. Intravenous pyelogram (IVP) showed normally functioning kidney with normal ureteric outline.The patient was taken up for cystoscopy, which revealed a scarred area on the posterior wall of the bladder above the trigone with a fistulous opening. A probe was passed through the fistulous opening in the vagina and the fistulous opening in the bladder was localized by cystoscopy being done at the same time. In view of the prolonged history of the patient, multiple surgeries and small size of the fistula, a decision was taken to attempt sealing of the fistula with fibrin sealant .Under cystoscopic guidance and local anaesthesia, a probe was passed through the fistulous opening in the vagina and margins of the fistula traumatized, in an attempt to freshen the margins. The cystoscope was removed and 2ml of reconstituted fibrin glue (Tissucol) was injected into the fistulous opening in the vagina using a Duploject syringe. The patient was then put on a continuous Foley's catheter for seven days. The patient had no leakage of urine in the postoperative period. The patient had no incontinence of urine after catheter removal and she was voiding satisfactorily. The patient was followed up at three months, when she was found to be asymptomatic and extremely satisfied with the procedure.

Interposing layer of fibrin glue: A new horizon in vesico-vaginal fistula repair

“…In another Multi-Institution Randomized Trial by Safran and Shekhar, 5 comparing fibrin glue (prepared from patients own blood) versus martius flap interpositioning in the repair of complicated obstetric vesicovaginal fistula it was seen to have higher success (80%) for fibrin glue as compared to martius flap (60%). Kapur and Rana 6 reported the successful use of bovine collagen along with fibrin glue in management of VVF in a 41 year old lady. Morita and Tokue 7 reported successful closure of a radiation induced vesicovaginal fistula with the endoscopic injection of reconstituted fibrin glue (Tissucol).…”

Vesicocervical Fistula: A Rare Complication of Lower Segment Caesarean Section

“…Most vesicervical fistulas are complications of caesarean section with symptoms of urinary incontinence 7,9,10 . Other possible causes include rupture of the lower uterine segment and bladder due to a traumatic forceps delivery, tuberculosis of the bladder and a perforation of an intrauterine contraceptive device into the bladder 6,7 .…”