Surgical repair of Vesico-Vaginal: Vaginal route versus abdominal route.

Objective: To determine outcomes and complications of vesico-vaginal fistula repair via vaginal and abdominal route. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation, Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: January 2020 to December 2020. Material & Methods: Patients having vesicovaginal fistula irrespective of age and fulfilling our inclusion criteria were included in the study using non-probability consecutive sampling technique. Patients having very large fistula, fistula involving neck of urinary bladder, failure of previous operation, patients with malignancy or co-morbidities were excluded from the study. Vaginal and abdominal approaches were used for fistula repair depending upon the level of fistula. Those operated via vaginal route were kept in trans-vaginal group and those operated via abdominal route were assigned trans-abdominal group. Results: Total 35 cases were studied having age 16-45 years with mean age of 32.6 ± 4.2 years. Transvaginal fistula repair was done in 37.1% and transabdominal repair was done in 62.8% cases. Most common cause of VVF was previous gynecological surgery in 77% cases. Success rate was 100% in transvaginal fistula repair as compared to 95.4% success rate achieved in transabdominal repair of fistula. Conclusion: Trans abdominal and transvaginal route both are good approaches but Transvaginal route of fistula repair is associated with high success rate than transabdominal route with minimum complications and better outcomes but it needs expert surgeon.

VESICO-VAGINAL FISTULAE;

Objectives: To review the causes, diagnosis and treatment of vesico-vaginalfistulae in the department of Gynaecology& Obstetrics, and Urology Department Civil HospitalQuetta. Background: Vesico-vaginal fistula is not life threatening medical disease, but the womanface problems like demoralization, isolation, social boycott and even divorce. The etiology ofthe condition has been changed over the years and in developed countries obstetrical fistulaare rare and they are usually result of gynecological surgeries or radiotherapy. In countrieslike Pakistan the situation is different, here literacy rate is low, parity rate is high and medicalfacilities are deficient. People manage delivery at home and usually multi parity. Urogenital fistulasurgery doesn’t require special or advance technology but needs experienced urogynecologistwith trained team and post operative care which can restore health, hope and sense of dignityto women. Methods: A retrospective study of 60 patients with different types of vesico-vaginalfistula werereviewed between January 2005 to December 2008. Patients were analyzed withregard to age, parity, cause, diagnosis, mode of treatment and outcome. Patients were alsoevaluated initially according to prognosis. Results: During the study of four year period 60patients of vesico-vaginal fistulae were reviewed. Majority of the patients were belonging tomiddle age group. In 48 patients repair was done through transvaginal route and 12 wereoperated through transabdominal route. One Ca patient expired and in 4 patients recurrenceoccurred. Conclusions: Iatrogenic vesico-vaginal fistulae are more common. Difficult andcomplicated fistulae need experienced surgeon. Establishment of separate fistula surgery unitis suggested to get desired results.

Genito urinary fistula: a series of 1704 cases

Aims: To review our experience in causes, diagnosis and basic principles of surgical treatment of urogenital fistulas. Methods: A retrospective study of 1704 patients with different types of urogenital fistulas were reviewed between October 1995 to October 2018. They were analyzed with regard to age, parity, casual factor, mode of treatment and outcome. Patients were also evaluated at two or three weeks initially, three monthly and later depending upon symptoms. Results: We reviewed our series of female urogenital fistulas that have been treated over a 22 years period. Out of these 1704 cases 864 (62.44%) were Vesico vaginal fistulas, 432 (25.35%) were Urethro vaginal fistulas and 188 (12.2%) were Uretero vaginal. Majority of the patients were young in child bearing age between 16 and 30 years of age, although age range was wide i.e., 11 to 50 years. The most common cause of urogenital fistulas were Obstetrical trauma due to obstructed labor in 400(37.59%) & Gynecological (hysterectomy 180(18.79%) & caesarian section in 72 (6.77%). Patients of Uretero vaginal fistulas were mainly due to unrecognized ureteral injuries during Gynecological procedures (hysterectomy in 136 cases & caesarian section in 10 cases. For repair of vesico vaginal fistulas Transvaginal route for repair was used in 424(39.84%) patients, while Thans abdominal route for repair was used in 560 (52.63%) patients. There were 32 (12.03%) failures in Vesico vaginal fistulas with a success rate of 88%. Mean Hospital stay was 15+ 3.5 days (range 4-30 days) and a mean follow-up of 8+ 3.2 months (range 4 months to 2 years). Conclusions: Management of Urogenital fistulas are among the most distressing complications of obstetric and gynecologic procedures. The patients suffer physically, emotionally and socially. The lack of skilled supervision and adequate obstetric emergency facilities are to blame.

Results of urogenital fistulas repair using caravan approach in Côte d’Ivoire

Aims: To report the experience of surgical caravans for urogenital fistulas care. Methods: It was a retrospective study covering the period from January 1st 2014 to December 31st 2014 and which took place on 7 sites of fistula care. The epidemiological, anatomic, clinical, therapeutic and evolutionary aspects were studied. Recruitment was made by radio announcements and word of mouth approaches. Treatment was free of charge for patients. Results: During 14 caravans 346 patients were operated. Their mean age was 33.11 years (12 - 70 years). Most of these patients were without remunerative activities (80%) and without education (63.3%). They had been living with fistula for 6.08 years on average (0 to 42). Obstetrical etiology was predominant (87.9%), the otherswere iatrogenic and traumatic. According to the Kees Waaldijk classification, fistulas were distributed as follows: type I (67.4%), type II Aa (12.7%), type II Ab (8.4%) and type III (11.5%). The most common surgical approach was the transvaginal route (82.1%). The vesicovaginal splitting with separated suture of the bladder and the vagina was the basic technique (94.7%). The therapeutic results were judged after a follow-up of 1 month and 3 months. Lost to follow-up within that period was 23% i.e. 80 patients in month one and 70% (245 patients) at month three. The success rates evaluated in patients reviewed at month one and at month 3 were respectively 70% and 64%. Conclusions: Caravan approach to recruit patients with fistula was feasible using local advertisements mans. Patients have been living with fistula for long time. Follow-up was difficult at Month 3.

Surgical management of simple Vesicovaginal fistulae

Objective: Vesicovaginal fistula is a fairly common occurrence in our country because of poor availability of obstetric care. The purpose of this study is to review our results in the surgical management of VVF.Design: Prospective study. Place and duration of the study: The study was conducted in the department of urology, Federal Government Services Hospital (F.G.S.H.); Islamabad, from February 2002 to January 2004. Patients and Methods: Eleven patients were operated for vesicovaginal fistulae. Transvaginal repair was done in 8 (72.7%) patients while transabdominal repair was adopted in 3 (27.3%) patients only. Inclusion criteria: All patients presented with vesicovaginal fistulae only. Exclusion criteria: All patients presented with genitourinary fistulae other than VVFs. Results: The majority of fistulae (10 (90.9%)) were caused by ischaemic necrosis of bladder and vaginal walls resulting from obstructed labour. One (9.1x) patient developed VVF after hysterectomy due to some gynaecological problem. Surgical repair proved to be successful through transabdominal route in all 3 (100%) cases of VVFs while in 6 (75x) of 8 (100%) cases through transvaginal route. To describe an overall result, 9 (81.8%) vesicovaginal fistulae were successfully repaired at first attempt. Conclusion: Vesicovaginal fistulae can be best managed following basic surgical principles like adequate exposure, identification of structures, wide mobilization, tension free closure, good haemostasis and uninterrupted bladder drainage.