Management of vesicovaginal fistulae in urological context.

OBJECTIVE To find out the commonest cause of vesicovaginal fistula (VVF) and describe the surgical management. DESIGN A descriptive study. PLACE AND DURATION OF STUDY The Department of Urology and Transplantation, Pakistan Institute of Medical Sciences (P.I.M.S.) Islamabad, from January 1995 to April 2002. PATIENTS AND METHODS The subjects were presenting with vesicovaginal fistulae. Symptomatology and demographic causes were noted. Investigation included IVU, cystoscopy, vaginoscopy and examination under anesthesia. Repair and outcome was noted. Patients presented with genitourinary fistulae other than VVF were excluded from the study. RESULTS Most of the patients were young women of childbearing age. The causative factor of VVF in 27 (84.3%) out of 32(100%) patients was obstetrical trauma. Surgical repair proved to be successful through transabdominal route in all 24 (100%) cases of VVF and in 4 (80%) out of 5 (100%) cases through transvaginal route. Repair failed in the 2(100%) attempted through abdominovaginal route and 1(100%) through endoscopic fulguration. To describe an overall result, 28 (87.5%) vesicovaginal fistulae were successfully repaired at first attempt. CONCLUSION Obstetrical trauma was the commonest cause of VVF in this series. Transabdominal repair was the most successful method of repair in this series. Despite the good results of surgical repair, attempt should be focused on the prevention of VVF.