A Review of the Management of Vesico-vaginal Fistula with Co-existing Bladder Calculi in South-East Nigeria

Abstract

Objective: Vesico-vaginal fistula (VVF) may co-exist with bladder calculi. Traditionally, management entails removal of the calculus and deferment of fistula repair. The study aims to present our findings in the management of women with this combination.Methodology: This is a retrospective review of twenty-three women with vesico-vaginal fistula and bladder calculi managed from December 2008 to June 2014 at the National Obstetric Fistula Centre, Abakaliki, Nigeria. The case history, physical findings, investigation results, operation notes and follow-up notes of twenty women were available and form the basis of this review. Results:The prevalence of bladder calculi among vesico-vaginal fistula patients was 1.45%. Most of the bladder calculi were removed via the transvaginal route. In majority of cases (55%), removal of the calculi and repair of the fistula were performed at the same sitting. Ninety-five percent of the patients had successful repair. Conclusion:These findings suggest that the co-existence of bladder calculi and vesico-vaginal fistula is uncommon. Clinical diagnosis is usually sufficient. Fistula repair could safely be undertaken at the same sitting with removal of the calculus in well-selected cases suggesting a paradigm shift in the management of this combination.

Obstetric fistula policy in Nigeria: a critical discourse analysis

“…This shortage in maternal health services heighten women’s risk to obstetric fistula in Nigeria. While improved medical management of fistula does enhance the lives of affected women [ 24 , 42 ], there are ambiguities in the long-term appropriateness of discrete curative approaches to the broader mission of eliminating obstetric fistula in Nigeria. For example, in Nigeria, fistula repair camps are conducted intermittently where certain numbers of fistulas are repaired [ 42 ].…”

“…While improved medical management of fistula does enhance the lives of affected women [ 24 , 42 ], there are ambiguities in the long-term appropriateness of discrete curative approaches to the broader mission of eliminating obstetric fistula in Nigeria. For example, in Nigeria, fistula repair camps are conducted intermittently where certain numbers of fistulas are repaired [ 42 ]. Although these fistula treatment sites are a promising strategy for reducing the number of women awaiting fistula treatment, this method does not suffice for preventing new cases of fistula.…”

Associated Morbidities Seen in Women with Obstetric Fistula

“…This may be as a result of reduced water intake as a coping mechanism for urine leakage. It also predisposes to bladder stone formation [21]. In UTI was seen in 61.5% of women with fistula in Abakaliki, Nigeria [4].…”