Clinical Profile of Urogenital Fistula in Kathmandu Model Hospital

Background: To determine the causes of fistula and to share our experience in treating urogenital fistula and its surgical outcome.Methods: This was a retrospective study done at Kathmandu Model Hospital from January 2014 to June 2019 including 261 patients operated for fistula. The patients were analyzed for age, type of fistula, cause, treatment and surgical outcome.Results: Out of 261 patients operated, 59.38% cases had obstetric fistula, 38.69% had iatrogenic and 1.92% had traumatic fistula. Most of the patients with obstetric fistula were between 21 to 25 years of age whereas iatrogenic fistulae were between 46-50 years of age. The majority (54.84%) of obstetric fistulae were vesicovaginal fistula (54.84%) while the commonest type (77.36%) of iatrogenic fistula was vault fistula after abdominal hysterectomy. Conclusions: This study showed that obstructed and neglected labor was still the major cause of genitourinary fistula in Nepal nevertheless iatrogenic fistula following pelvic surgery is increasing. The surgical outcome of repair of fistula was good.Keywords: Latrogenic fistula, obstructed labour, urogenital fistula.

Vesicovaginal Fistula Post Caesarean Hysterectomy

Genitourinary fistula is an abnormal communication between the urinary tract and genital tract, most common being the vesicovaginal fistula. In most of the cases fistula results mainly due to poor obstetric care in developing countries, where as in developed countries most of the urogenital fistulas are iatrogenic. It is mainly diagnosed by clinical examinations and intravesical dye test using methylene blue. Repair can be done via abdominal or vaginal route based on the findings. Here we present a case of 27 years postnatal mother referred to our centre with diagnosis of vesicovaginal fistula post cesarean hysterectomy that was repaired successfully via vaginal approach. Keywords: cesaerean hysterectomy, urinary leakage, vesicovaginal fistula

Laparoscopic sigmoid vaginoplasty: a salvage option for genitourinary fistula after failed McIndoe’s repair

A 30-year-old woman presented with vesicovaginal fistula after a forceful intercourse. She was diagnosed as a case of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome 14 years ago and had underwent McIndoe’s vaginoplasty using amniotic membrane. Similarly, another 14-year-old girl presented with an iatrogenic urethral and bladder neck injury during an attempt at McIndoe’s vaginoplasty 4 months ago at another centre leading to urinary fistula with absent vagina. A laparoscopic salvage was done for both the cases along with repair of genitourinary fistula using sigmoid colon. There was no further requirement of vaginal dilation. Both patients remain fully continent at 1 year follow-up. Laparoscopic sigmoid vaginoplasty is a worthy minimally invasive salvage method for the patients of MRKH who develop fistulous complication after a previous attempt at neovagina creation. The bowel wall provides a structurally strong layer to withstand the repeated sexual trauma of the vagina.

Vesico-uterine fistula associated with secondary infertility: A case of successful repair

Genitourinary fistulas usually have devastating consequences on a woman's reproductive health. vesicouterine fistulae though uncommon variant of genitourinary fistula, are usually due to iatrogenic etiologies. The case reported was diagnosed after second caesarean section when she was being evaluated for secondary infertility. Keywords: Youseff 'syndrome, Amenorrhea, Caesarean Section, Fistula,

Iatrogenic Genitourinary Fistula: Changing Trends

Aims: To study the frequency of iatrogenic cause amongst the surgery done for genitourinary fistula and to study the type and cause of iatrogenic genitourinary fistula. Methods: This is retrospective study of women undergoing surgery for genitourinary fistula repair from year 2013 to 2018. The analysis considers frequency and characteristics of type of fistula. Results: Out of 223 genitourinary fistula 75 (33.6%) were iatrogenic. Vaginal vault fistula were 25% followed by uretero-vaginal fistula (32.9%), vesico-vaginal fistula (32.9%) and there were 4 iatrogenic recto-vaginal fistula; 81.6% of the iatrogenic fistula had preceding history of hysterectomy followed by emergency caesarean section (17.1%). There is annual increasing trend in iatrogenic fistula repair from 3 to 23. Conclusions: Women undergoing hysterectomy were under risk for iatrogenic fistula. Optimum work environment is important to reduce surgical error during procedures. Operating training should be emphasised on optimal surgical skills, decision making. Keywords: genitourinary fistula, ureteric fistula, vault fistula