Repair of vesicovaginal fistula using fresh placental membranes

ABSTRACT

Simple vesicovaginal fistulas are usually due to local trauma. The commonest cause, worldwide, is tissue necrosis following prolonged obstructed labor. The causes of recurrence are unhealthy tissue and under-tension of the sutures. Five women suffering vesicovaginal fistulas were operated upon. Three cases were complex and 2 cases were simple with an average age 27.9 years. The sites of the fistulas of the 3 complex cases were in the upper part of the trigone and that of the 2 simple cases were above the left ureteric orifice. Placental membranes amnion and chorion were sutured to the urinary bladder wall defect, leaving the mucosa unsutured. Urethral catheter was adopted for 14 days. The follow up was excellent. Clinical examination and ascending cystogram revealed no recurrence. Mucosal and detrusal regeneration along the placental patch was evident by pathological examination