Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Abstract

Vesicovaginal Fistula (VVF), an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODSA total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21 st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULTOf the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSIONIn spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate, prevention of early marriage-all are of paramount importance for the prevention of occurrence of this socio-medical problem.

Vesicovaginal Fistula (VVF): Success of primary repair.

“…15 While another study conducted at tertiary case hospital of west Bengal Showed a bit lower success rate of 87.3%. 13 Another study conducted at Jimma university teaching hospital Ethiopia showed a success rate of 93.4% which is again comparable to my study. 14…”

“…In this study 66.7% patients were having obstetric fistulas similar to some local and international studies 11,12 In another study conducted at a tertiary care hospital of west Bangal, 66% cases of VVF were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological etiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. 13 Among the 10 patients having obstetric fistulas, 7 were having home delivery and 3 were having delivery at some center by untrained personnel. This again is in sharp comparison to some of studies cited above.…”