A fistula is an abnormal connection between two luminal structures of different epithelium. The majority of urological fistulas in developed countries are consequences of iatrogenic injury most commonly laparoscopic hysterectomies, or from radiotherapy in the treatment of pelvic cancers.1 Contrary to this, most obstetric fistulas in developing countries result from obstructed labour during childbirth.2 Common factors that contribute to obstructed labour in developing countries are delayed presentation after trial labour at home, cephalopelvic disproportion and poor nutrition. Due to prolonged compression by head on the pelvic tissues there happens ischemic necrosis of vagina, bladder neck, and urethra3 called obstructed labour complex. Necrosis and fibrotic healing lead to fistula formation with adjacent structures. The vesicovaginal fistula was the most frequent one (78 %) and the common site involved was trigone (51 %) and based on the level it could be a high or low fistula. Others are vesicouterine fistula, vesicourethral fistula, vesicoureteral fistula and rarely vesico-salpingo fistula. During the acute phase of fistula, tissue oedema, hypovascularity, infection, and nonviable tissue hinder proper tissue healing and hence delayed repair is done after 3 months. Recent literature advises early repair for simple fistulas to reduce patient morbidity and delayed repair of complex fistula, multiple fistulas, infected fistulas, post-radiotherapy, fistula due to foreign bodies, immunocompromised patients, hypoproteinaemia patients, urosepsis patients. 4 Fistula repair is preceded by contrast evaluation of ureter and bladder by CT –IVU and cystogram or MRI followed by cystoscopy or retrograde pyelography. Apart from fistula closure, bilateral ureteric implantation may be needed if ureters are close to the fistula. 5 Abdominal hysterectomy is done in uterovesical fistulas. Huge fistulas close to the bladder neck cannot be repaired without compromising continence hence bladder neck closure is done with the Mitrofanoff procedure. 6 A vesico-salpingo fistula is an abnormal epithelial-lined communication between the urinary bladder and the fallopian tube. This rare type of urogenital fistula has only 7 previously published cases in the literature.
Managing intractable incontinence from a Yang-Monti channel in a case of enterocystoplasty with bladder neck closure – Challenges and a modified surgical technique
