Vesicovaginal fistula in Sudanese women.

esicovaginal fistulas are among the most distressing complications of obstetric and gynecologic procedures, they can result from obstetric trauma (obstructed labor), surgery, infections, congenital anomalies, malignancy and radiation.1 As each fistula is unique, there are many controversies regarding the proper surgical repair of vesicovaginal fistulas where surgeon has to see the best time and procedure to suit the specific problem. Regardless of whether a transvaginal or transabdominal approach was selected, the concepts of using healthy tissue in tension-free closure and reinforcing the closures in high risk situations will ensure success.2 This study was conducted to investigate the causes, presentations and to compare the outcomes of the vaginal versus abdominal repair. We performed a prospective and descriptive study during the period January 2001 to December 2002 at Wad Medani Teaching Hospital, Sudan. Sudanese women presented with vesicovaginal fistulas were approached to participate in the study. The details of socio-demographic characters, full clinical, obstetrical and gynecological histories were recorded. All patients were examined clinically where the fistulas were inspected directly using speculum vaginal examination and cystoscopy to visualize the ureteric orifices. In some patients the diagnosis was confirmed by filling the bladder with diluted solution of methylene blue. The aim of the study was to repair small (<0.5cm), single, simple (non-recurrent) and low fistulas (according to ureteric orifices) via transvaginal approach. Different vaginal repair techniques were used according to the case itself, however, these were generally the modifications of the Latzko procedure or a layer closure with or without Martius flap.3,4 For those repairs involving large, recurrent, non-pelvic organs and high fistulas the transabdominal approach was used with a suitable flap.5 We recommended a period of 8 weeks from the onset of fistulas before repair and 2 gm of intravenous ceftriaxone was used as prophylactic antibiotic. Urethral catheters were left in place for 2 weeks following the operations. All patients were followed for at least 3 months. Successful repair was defined as complete dryness for one month following removal of the catheter. Fifty Sudanese women with vesicovaginal fistulas were presented to our center during the 2-years period of the study. Obstructed V Table 1 Comparison of different variables of patients with vesicovaginal fistulas on patients where vaginal or abdominal repair was performed.