Vesicovaginal Fistula (VVF): Success of primary repair.

Abstract

Objectives: The main objective of this research is to determine success of primary repair of vesicovaginal fistula at tertiary care hospital. Study Design: Quasi Experimental. Setting: DHQ Hospital, Faisalabad, Obstetrics and Gynaecology Department. Period: From Mar 2015 to Mar 2017. Material & Method: 15 patients were enrolled by consecutive sampling and those having fistulas more than 4cm or involving ureteric orifice, bladder neck or urethra were excluded. After proper history examination, preliminary investigations and EUA, fistula repair was done. All information recorded on proposed proforma for this purpose. Results: Among all 15 patients, 10(66.7%) were having obstetric fistulas and 5(33.3%) were with non obstetric fistula. 07 (46.7%) had home delivery, 3(20%) had delivery at center by untrained persons, 3(20%) had hysterectomy by untrained surgeons i.e. 1(6.7%) for endometriosis, 1(6.7%) for multiple fibroids and 1(6.7%) for ovarian malignancy while 2(13.3%) patients had inducted miscarriages by midwives. 12 (80%) patients had subtrigonal and trigonal fistulas, so underwent transvaginal repair and rest 3(20%) had supratrigonal fistula so transabdominal repair was done. Success of repair was 93.3% (14) and 1 was complicated with failed fistula repair. Conclusion: Most fistulas encountered in this study were caused by obstetrics trauma and are preventable. In existing cases of vesicovaginal fistula, properly trained health professionals with impeccable evaluation, prudent decision about route and technique of repair and good post operative care are key points in success of surgical repair.

Surgical repair of Vesico-Vaginal: Vaginal route versus abdominal route.

“…They determined success rate of 93.3% by primary repair of VVF by Transabdominal and transvaginal route combined. 19 A study conducted in UK concluded that there is no difference in success rate of VVF repair done via any one of two approaches transabdominal or transvaginal approach and transvaginal approach is more cost effective than transabdominal approach. 20…”