ABSTRACT
Background: Vesicovaginal fistula (VVF) is an abnormal opening between the bladder and the vagina that results in continuous and unremitting urinary incontinence. It is the most distressing complications of gynecologic and obstetric procedures. Materials and methods: It was a prospective study conducted at Gandhi Medical College and Hospital in Department of Urology from February 2014 to July 2015 for a period of 18 months. All cases were subjected to clinical examination, ultrasonography, IVP, cystoscopy, vaginoscopy, and cystogram for confirmation of diagnosis. All cases were managed surgically by different modalities and results were analyzed. Results: Our study included the patients in the age group of 18 to 56 years. 22 patients presented with continuous urine leak with voiding and 13 patients presented with voiding in addition to incontinence of urine. Out of 35 cases 25 were secondary to Gynecological surgeries and 10 were of Obstetric fistulas. Conclusion: The diagnosis of VVFs has traditionally been based on clinical methods and dye testing. The best chance of a successful repair is at the first attempt. The arguments about the most appropriate route for repair continue and are not clarified by the publications so far. However, the role of interposition grafts at both abdominal and vaginal repairs is viewed positively.
ABSTRACT
Background: Vesico-vaginal fistula is a common problem that has public health significance. Aims: To determine the epidemiology, causes as well as the outcomes of VVF repair in the Department of Obstetrics and Gynaecology State Specialist Hospital Maiduguri, Borno State of Nigeria. Methods: A ten year (Jan 1998 to Dec 2007) retrospective review of the patients’ records, operation theatre records and Gynaecological clinic records of patients with vesico-vaginal fistula. Results: Three hundred and eighty five (385) VVF repair were done out of 2105 gynaecological operations during the study period, giving a prevalence of 18.3%. Three hundred and forty seven (347) patients records were analysed. Most (51.9%) of the fistulae occurred in women aged 15-24 years. The patients are mostly married (79%), primiparas (56.5%), uneducated (89%) and not salaried employed (99.4%). Obstetrics complication was the commonest cause of VVF. The overall success rate of repair was 59.1%. Success of repair decreases as the number of fistula or complexity of fistula increases (p<0.0001). Conclusion: Vesico-vaginal fistula is mainly caused by prolonged obstructed labour. Complexity of fistula was associated with poor surgical outcome. Interventions that will improve access to trained delivery attendant will minimise the occurrence of prolonged obstructed labour and that will go a long way to decrease the incidence of vesico-vaginal fistula.
ABSTRACT
38 cases of Vesicovaginal fistula were repaired. Among them 11 cases were Complicated V. V. F. Three operative methods were reported: Using musculus bulbocavenosus island flap, the huge Vesico-vaginal fistulae were successfully repaired. Using anastomosis of artificial fistula on the bladder with remnant urethra, the huge V. V. F with urethral trauma were repaired. Extraperitoneal and intracesical repairing cured high position and huge V. V. F. The report put forward the principlle the the simpler the method the better the result when repairing complicated V. V. F. V. V. F. could only be cured by surgical operation.