Eight Years Experience in the Surgical Management of Vesico- Vaginal Fistula

Aims: To review the aetiology and success of transvaginal repair in simple vesicovaginal fistula cases. Objective: To review the aetiology and success of transvaginal three layer repair with delayed absorbable suture material in simple vesicovaginal fistulae cases. Design: Prospective study. Place and duration of study: This study was carried out in DHQ Hospital, Faisalabad over a period of eight years from December 1996 to December 2004. Patients and methods: Patients were admitted through gynaecology outpatient department. Patient’s age, socio-economic status, education, nutritional status, obstetrical history, previous history of surgery, i.e., caesarean section, caesarean hysterectomy, abdominal hysterectomy, vaginal hysterectomy and repair, previous history of vesicovaginal repair were noted. Complex fistulae, postradiation fistulae and fistulae requiring repair other than transvaginal route were excluded from the study. Results: During eight years study period sixty patients with a history of true urinary incontinence were confirmed to be patients of simple vesicovaginal fistulae. 52(86.6%) patients developed vesicovaginal fistula after obstructed labour. 4(6.6%) had gynaecological operation as the primary cause for their fistula while the remaining 4(6.6%) resulted from the instrumental delivery by untrained doctors. Conclusion: 56(93.2%) patients of vesicovaginal fistulae resulted after obstructed labour and instrumental delivery. Vesicovaginal fistula can be successfully managed surgically. Standard obstetrical care can reduce such occurrence.