Vesico-vaginal fistulae; review of the causes, diagnosis and treatment

ABSTRACT

To review the causes, diagnosis and treatment of vesico-vaginal fistulae in the department of Gynaecology and Obstetrics, and Urology Department Civil Hospital Quetta. Vesico-vaginal fistula is not life threatening medical disease, but the woman face problems like demoralization, isolation, social boycott and even divorce. The etiology of the condition has been changed over the years and in developed countries obstetrical fistula are rare and they are usually result of gynecological surgeries or radiotherapy. In countries like Pakistan the situation is different, here literacy rate is low, parity rate is high and medical facilities are deficient. People manage delivery at home and usually multi parity. Urogenital fistula surgery doesn't require special or advance technology but needs experienced urogynecologist with trained team and post operative care which can restore health, hope and sense of dignity to women. A retrospective study of 60 patients with different types of vesico-vaginal fistula werereviewed between January 2005 to December 2008. Patients were analyzed with regard to age, parity, cause, diagnosis, mode of treatment and outcome. Patients were also evaluated initially according to prognosis. During the study of four year period 60 patients of vesico-vaginal fistulae were reviewed. Majority of the patients were belonging to middle age group. In 48 patients repair was done through transvaginal route and 12 were operated through transabdominal route. One Ca patient expired and in 4 patients recurrence occurred. Iatrogenic vesico-vaginal fistulae are more common. Difficult and complicated fistulae need experienced surgeon. Establishment of separate fistula surgery unit is suggested to get desired results: