DOI: http://dx.doi.org/10.18203/2349-2902.isj20190402

An outcome of the management of vesico-vaginal fistula: experience at KIMS, Hubli, Karnataka, India

Rajivkumar R. Jadav, Manjuprasad G. B.

Abstract


Background: Vesicovaginal Fistula (VVF), an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problems for the females. The present retrospective study was done to analyse the demographic and aetiologic pattern of vesicovaginal fistula and to ascertain the outcomes of its surgical management following different techniques of repair in a tertiary care centre.

Methods: Retrospective analysis of case records of 24 cases treated between January 2015 to July 2017 at Department of Urology KIMS, Hubli was done. Duration of symptoms, mechanism of injury, radiological and biochemical reports, cystoscopic recordings of patients and operative records were analysed.

Results: Mean age was 40.8 years (range 20-70 years). Fistula size varied from 0.5-5cm. location of the fistula was supratrigonal in 20 cases (84%) and trigonal in 4 cases (16%). Fitula was simple in 16 cases (68%) and complex in 8cases (32%). 21 cases were treated by open surgical method and laparoscopic technique in 3 cases. VVF repair was done by abdominal approach in 17 (67%) cases and by vaginal approach in 4 (33%) cases. Cases were followed for 2 -25 months. success rate of 100% (3 cases) who were operated laparoscopically and 17/21 (80.95%) in patients treated by open surgical method was noted. Failures in present study could be attributable to extensive fibrosis especially in prior failed repairs and in those with prolonged duration of symptoms.

Conclusions: In the present study complex fistulas had higher failure rate. The principles of fistula repair, experience of surgeon and case selection remain important determinants of outcome.

Keywords


Supratrigonal fistula, Trigonal fistula, VVF, Vesico-vaginal fistula

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References


Garthwaite M, Harris N. Vesicovaginal fistulae. Indian J Urol. 2010;26:253-6.

Puri M, Goyal U, Jain S, Pasrija S. Letter to Editor-a rare case of vesicovaginal fistula following illegal abortion. Indian J Med Science 2005;59(1):30-1.

Takeda T, Nishiyama T, Ohara R, Hasegawa S. Vesicovaginal fistula after sexual intercourse: a case report. Hinyokika kiyo. Acta Urol Japonica. 2007 Mar;53(3):191-2.

Evans DA, Moore AT. The first case of vesico-vaginal fistula in a patient with primary lymphoma of the bladder–a case report. J Med Case Reports. 2007 Dec;1(1):105.

Mubeen RM, Naheed F, Anwar K. Management of vesicovaginal fistulae in urological context. J Coll Physicians Surg Pak. 2007 Jan 1;17(1):28-31.

Hadley HR. Vesicovaginal fistula. Curr Urol Rep. 2002;3(5):401-7.

Dalela D, Goel A, Shakhwar SN, Singh KM. Vesical calculi with unrepaired vesicovaginal fistula: a clinical appraisal of an uncommon association. J Urology. 2003 Dec 1;170(6):2206-8.

Hodges AM. The Mitrofanoff urinary diversion for complex vesicovaginal fistulae: experience from Uganda. BJU Int. 1999 Sep;84(4):436-9.

Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstetr Gynecol Survey. 1996 Sep 1;51(9):568-74.

Kam MH, Tan YH, Wong MYC. A 12-Year Experience in the Surgical Management of Vesicovaginal Fistulae Int J Gynecol Obstetr. 2008;101(1): 35-38

Roy KK, Malhotra N, Kumar S, Seth A, Nayar B. Genitourinary fistula-an experience from a tertiary care hospital. JK Sci 2006 July-September; 8(3). 2006.

Kapoor R, Ansari MS, Singh P, Gupta P, Khurana N, Mandhani A, et al. Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach. Indian J Urol. 2007 Oct;23(4):372.

Eisen M, Jurkovic K, Altwein JE, Schreiter F, Hohenfellner R. Management of vesicovaginal fistulas with peritoneal flap interposition. J Urol. 1974 Aug;112(2):195-8.

Persky L, Herman G, Guerrier K. Nondelay in vesicovaginal fistula repair. Urol. 1979 Mar 1;13(3):273-5.

O'Conor JV. Review of experience with vesicovaginal fistula repair. Transac Am Assoc Genito-Urinary Surgeons. 1979;71:120-2.

Mubeen RM, Naheed F, Anwar K. Management of vesicovaginal fistulae in urological context. J Coll Physicians Surg Pak. 2007 Jan 1;17(1):28-31.

Datta B, Chattopadhyay S, Mandal M. Vesicovaginal fistula: our experience of 47 cases in a tertiary care hospital of West Bengal. J Evolution Med Dental Sci. 2016 Jun 13;5(47):3052-4.

Sotelo R, Mariano MB, GarciA-Segui A, Dubois R, Spaliviero M, Keklikian W, Novoa J, Yaime H, Finelli A. Laparoscopic repair of vesicovaginal fistula. J Urol. 2005 May 1;173(5):1615-8.