Simultaneous repair for complicated/ complex vesicovaginal fistula

ABSTRACT

To determine the outcomes of repair of complicated/complex vesicovaginal fistulae [VVF] by simultaneously abdominal and vaginal approach. Prospective descriptive study. This study was conducted at PUMHS, Nawabshah from Jan. 2008 to Dec. 2012. After routine clinical examination and investigation, patients having complicated/complex vesicovaginal fistulae were selected for repair. The patients having associated with colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Follow up was carried out weekly basis for 03 to 06 months. Our study comprises of only 12 cases having complicated/complex VVF. The mean age was 35 SD +/- 3.5 years. The mean size of fistula was 3.9 SD +/- 1.2 cm. The ureter and urethra were adjunct with fistula in 03 [25%] and 02[%] cases respectively. all cases were treated with aforementioned method and auto-cystoplasty was carried in 08 [66.5%] cases. The uni-lateral and bilateral ureteric re-implantation was attempted in 01 [8.5%] and 02 [16.5%] cases respectively and double J stent were kept in all these cases. The success was achieved in 09 [75%] cases. The short and long term complications like frequency/dysuia/urgency of micturation, urinary stress incontinence and dyspareunia that had occurred in 04 [33.5%], 02 [16.5%] and 05[41.5%] cases respectively. Simultaneously abdominal and vaginal approach should be considered as complementary add-on to improve the access in difficult instances from 02 sides. It authorizes the surgeon to excise the fistulous tract