VESICOVAGINAL FISTULA: AN EXPERIENCE OF 30 CASES AT AYUB TEACHING HOSPITAL ABBOTTABAD
AbstractBackground: Vesicovaginal fistula (VVF) is a disease that is rare in developed world but isfrequently seen in poorer countries. It is mostly a result of gynaecological or obstetricalprocedures. This study reports our experience of VVF. Methods: This study was carried out atdepartment of Urology, Ayub Teaching Hospital, Abbottabad from June 1998 to June 2004.Detailed history was taken to record age, nature of trauma, time interval of appearance of fistulaand previous attempts of repair if any. In addition the results of repair were evaluated. Results:During this six years study period a total of 30 cases of urinary incontinence due to VVF werereferred from Gynaecology and Obstetrics department for management, many gave history of birthtrauma resulting in leakage of urine per vaginum. Majority of patients with VVF were between 21-40 years of age. All the patients presented with total incontinence of urine. Most commonetiological factor was obstructed labour (63.33%). The other factors were caesarian section(13.33%), hysterectomy (13.33%), forceps delivery (3.33%) and bladder calculus (3.33%). Asingle case was due to carcinoma cervix and post irradiation (3.33%). Three out of 30 patients hadone or more previous fistula repair attempts, while in the rest repair was not attempted before. Wecarried out transvesical repair in all patients, 80% of patients were completely cured and symptomfree, 10% had stress incontinence with frequency of micturition but no vaginal leakage. Failurewas 10%. Conclusion: VVF is frequently encountered in Hazara division of Pakistan. It is mostlydue to obstetrical causes.Keywords: Vesicovaginal Fistula, urology, incontinence
Goodwin WE, Scordino PT. Vesicovaginal and
ureterovaginal fistulae, a summary of 25-years of experience,
J Urol 1980; 123-367. 14. Cortesse A, Colau A. [Vesicovaginal fistula]. Ann Urol
Tahzib F. An initiative for VVF. Lancets 1980; (i): 1316-7 (Paris) 2004;38(2):52-66. [Article in French]
Aarrowsmith SD, Genitocrimony reconstruction in obstetric
fistulae. J Urol 1991;152: 403-6
Rant V, Bhattacharye M. Vesical fistulae. An experience for
a developing country. J Postgrad Med;1993:39 20-1
Harrison KA. Children crippled by childbirth. People 1987;
Lawson J. Vaginal fistulae. J R Soc Med 1992; 85: 254-6.
Kelly J. Fistulae of obstetric origin (Scotland) midwifery
; 7(2): 71-3.
O’conor VJ Jr. In: Glenn JF Urolgic Surgery female urinary
incontinence. 2nd ed. Newyork;Hasper and Row;1975:755-81.9. Lawson J. Tropical Obstetric and Gynaecology practice in
North West Frontier Province. Paper presented At
Gynaecology and Obstetrics conference Lahore, December
Falandry L. Vesicovaginal fistula in Africa. 230 cases. Presse
Med. 1992;21(6):241-5. (Article in French)
Wall LL, Karshima JA, Kirschner C, Arrowsmith SD. The
obstetric vesicovaginal fistula: characteristics of 899 patientsfrom Jos, Nigeria. Am J Obstet Gynecol 2004;190(4):1011-9.12. Ramos Gutierrez V P. [Vesicovaginal fistula] Arch Esp Urol. 2002;55(9):1144- , Postius Robert J, Rodriguez Hernandez
(article in Spanish)13. Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R,
Bellati F, Croce C, Panici PB. Guidelines of how to manage
vesicovaginal fistula. Crit Rev Oncol Hematol.
;48(3):295-304.14. Cortesse A, Colau A. [Vesicovaginal fistula]. Ann Urol(Paris) 2004;38(2):52-66. [Article in French]15. Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S.
Ten-year experience with transvaginal vesicovaginal fistula
repair using tissue interposition. J Urol 2003;169(3):1033-6