Vesicovaginal fistula [VVF]

Vesicovaginal fistula is not an uncommon condition. It gives rise to multiple socio-psychological problems for women usually of younger age. It can be prevented by improving the level of education, health care and poverty. Early diagnosis and appropriate treatment is required to help the patient. Preoperative assessment, treatment of co-morbid factors, proper surgical approach and technique ensures success of surgery. Postoperative care of the patient is equally important to avoid surgical failure

Vesicovaginal fistula: a challenge for women in developing countries

An experience of 19 cases of vesiovaginal fistula [VVF] in Gynae unit III at Civil Hospital, Karachi during a period of 30 months is presented. The purpose of this study was to determine the etiology of VVF and the results of repair and how to prevent the causes of fistula formation. The majority [89.48%] of fistulae were caused by ischaemic necrosis resulting from obstetrical trauma. The flap splitting method of repair was used and most of the fistulae were approached per vaginum. Absorbable synthetic suture [vicryl no 2/0] was used for closure with good results. None of our cases needed interposition of tissues or urinary diversion. Repair was successful in 62.5% cases. Measures to prevent VVF formation are suggested because it is an avoidable condition as has been effectively eliminated from industrialized countries

Nova abordagem do ureter na cirurgia de Wertheim Meigs / New access of the ureter in the Wertheim Meigs surgery

Os autores fazem um histórico da cirurgia de Wertheim Meigs, sua indicaçao precípua e sua consecuçao. Relatam as complicaçoes decorrentes principalmente do descolamento excessivo do ureter de seu leito peritoneal. Mostram a evoluçao da cirurgia e a diminuiçao das fístulas uretero-vaginais. O intuito principal do trabalho é demonstrar uma nova abordagem do ureter nesta cirurgia, individualizando o ligamento pubo-vésico cervical inicialmente, permitindo uma adequada visualizaçao do trajeto ureteral.