Vesicovaginal Fistula: Repair by Vaginal Approach

Abstract

Objectives: To evaluate the outcome of trans-vaginal repair in vesicovaginal fistula even in cases having fistulous opening high in vagina or close to ureteric orifices.Methods: This study was carried out in Departments of Urology and Gynecology Lahore General Hospital from April 2004 to Oct 2007. Detailed history was taken; physical examination and relevant investigations were carried out. In extended lithotomy position, simultaneous cystoscopy and vaginal examination were performed in all cases. After identifying the fistula and ureteric orifices, trans-vaginal repair was done in all the cases. Results: Thirty cases of urinary incontinence for 3 months to 12 years, with age range of  18  to  49 years and their parity ranged from  1  to  6.  Sixty sixpercent fistulas were supra-trigonal and less than 2 cm (range1-4cm). It was seen that obstetrical causes (59.4%) overruled the gynecological ones (33.3%). Five patients had one or more previous fistula repair attempts; while one of the females had 4 deliveries even with the fistula. First repair attempt was successful in 27 (91.1%) cases, two of the remaining three were cured in 2^nd repair and last one was cured in third trans-vaginal attempt. None of the repair compromised the ureteric orifice. Conclusion: The vaginal approach avoids laparotomy, splitting of the bladder and ureter re-implantation in the cases having fistulae closed to the ureteric orifice. Patient recovery is faster with less morbidity.