• Attiya Ayaz
  • Rahat un Nisa
  • Sadia Anwar
  • Taj Mohammad


Background: Although the magnitude of obstetric fistulae (OF) is reported to have decreased inindustrialised countries, it is still a major problem in developing countries especially the fistulaeresulting from obstructed labour. Vesico-vaginal fistulae (VVF) are the most common and the mostfrequent type of urogenital fistulas. In most cases, surgery is required for treatment. The aim of thisstudy was to analyse the results of surgical treatment of VVF and Rectovaginal Fistulae (RVF) in atertiary level institution over 12 years period. Methods: This retrospective study was conducted atAyub Teaching Hospital, and Women and Children Hospital, Abbottabad. It included records of a totalof 74 patients who were surgically treated from 2001 to 2012. Results: Cause of VVF was obstructedlabour in 81.08% of cases, and it was iatrogenic in 18.92% cases. In the surgical treatment of primaryVVF transvaginal approach was used in 91.9%, while transabdomenal approach was used in 2.7%cases. In 54.1% of cases the VVF healed after a single surgical intervention, while in 45.9% casesmore-than-one operations were required. Conclusion: Birth trauma is still a major cause of VVF/RVFin our region. Prevention is possible with provision of sufficient health care and public awareness.Successful repair is possible with 1st surgery.Keywords: Obstetric fistulae, vesicovaginal fistulae, rectovaginal fistulae, iatrogenic, repair, women


AbouZahr C. Global Burden of Maternal Deaths and

Disability. Br Med Bull 2003;67(1):1–11.

WHO. Obstetric Fistulae: A Review of Available

Information. WHO/MCH/MSM/91.5; 1991.

Memon GU, Azam GA. Obstetric and Gynecological

Vesicovaginal Fistula. Med Channel 2005;11(3):11–4.

Hassan MA, Ekele BA. Vesicovaginal fistula: Do the patients

know the cause? Ann Afr Med 2009;8:122–126.

Proceedings of the Workshop on Data Methodologies for

Estimating Obstetric Fistula, New Delhi. 30 Apr– 2, May 2007,

Available at:


Semere L, Nour NM. Obstetric Fistula: Living with Incontinence

and shame. Rev Obstet Gynecol 2008;1:193–7.

Keri L, Kaye D, Sibylle K. Referral practices and perceived

barriers to timely obstetric care among Ugandan traditional birth

attendants. Afr Health Sci 2010;10:75–81.

Murk W. Experiences with obstetric fistula in Rural

Uganda. Yale J Biol Med 2009;82:79–82.

Wall LL. Obstetric vesicovaginal fistula as an international

public-health problem. Lancet 2006;368:1201–9.

Spettel S, White MD. The Portrayal of J. Marion Sims’

Controversial Surgical Legacy. J Urology 2011;185:2424–7.

Kelly J. Vesico-vaginal and recto-vaginal fistulae. J R Soc

Med 1992;85:257–8.

Ghatak DP. A study of urinary fistulae in Sokoto, Nigeria. J

Indian Med Assoc 1992;90:285–287.

Miller S, Lester F, Webster M, Cowan B. Obstetric fistula: a

preventable tragedy. J Midwifery Women’s

Health 2005;50:286–94.

Wall LL, Karshima JA, Kirschner C, Arrowsmith SD. The

obstetric vesicovaginal fistula: Characteristics of 899 patients

from Jos, Nigeria. Am J Obstet Gynecol 2004;190:1011–9.

Tsui AO, Creanga AA, Ahmed S. The role of delayed

childbearing in the prevention of obstetric fistulas. Int J Obstet

Gyaecol 2007;99(S1):S98–S107.

Ahmed S, Nishtar A, Hafeez GA, Khan Z. Management of

vesicovaginal fitulas in women. Int J Obstet Gynecol


Parveen F, Shah Q. Vesicovaginalfistula. A challenge for women

in developing countries. J Coll Physicians Surg Pak


Rafia B, Hafizullah, Jalbani M, Deenari R. Vesicovaginal

fistulae: A surgical outcome; J Surg Pak 2003;8(1):10–3.

Khan AL, Bano A, Khan M. Veicovaginal Fitula; surgical

management. Professional Med J 2004;11(3):261–5.

Mumtaz F, Yousafani S. An experience of VVF repair at

Gynecological surgical camp at Hyderabad From 15-18 Oct

Med Channel 2001;7(1):42–4.

Nargis S, Raheela, Shereen. Six years experience of repair of

vesiocovaginal fistulae at gynae unit 11 Civil Hospital Karachi.

Med Channel 2007;13(3)67–9.

Corman ML. Recto vaginal fistulas. In: Colon and Rectal

Surgery. 2nd ed. Philadelphia: JB Lippincott;1989.

Perez CA, Breaux S, Bedwinek JM, Madoc-Jones H, Camel HM,

Purdy JA, et al. Radiation alone in the treatment of carcinoma

uterine cervix -I. Analysis of complications. Cancer




Most read articles by the same author(s)