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

Abstract

Rare cases of VVF have been reported after illegal abortion. 2 and vigorous sexual activities. 3 One rare case of VVF due to primary lymphoma of urinary bladder has been reported by Evans et al. 4 The physical and psychological impact of constant urinary incontinence from a VVF can be overwhelming because of the burden of continual wetness, undesirable odors, vaginal and bladder infections, and related discomfort. Despite advances in the management, VVF repair remains technically challenging. The success rate 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.

Magnitude of repair failure and associated factors among women undergone obstetric fistula repair in Bahir Dar Hamlin Fistula Center, Amhara Region, Northwest Ethiopia

“…2,13,20,21 The reason for the higher rate of repair failure might be because of the differences in diagnostic accuracy, evaluation and timely repair using procedures that exploit basic surgical principles and the application of interposition flaps. 22,23 Weight of women during repairing was the factor for OF repair failure. Women who were less than 50 kg at repairing were 3.43 times more likely for OF repairing failure than their counterparts.…”

Obstetric fistula repair failure and its associated factors among women underwent repair in Yirgalem Hamlin fistula center, Sidama Regional State, Southern Ethiopia, 2021: a retrospective cross sectional study

“…Fistula characteristics such as large fistula size [ 6 , 16 , 18 , 19 ], Goh Type 3, or Type 4 fistulas [ 16 , 18 ], past repair history [ 6 , 17 , 18 ], urethral damage [ 8 , 19 ], and moderate to severe vaginal scarring [ 18 , 19 ] have also been described as risk factors for repair failure. Peri-operative factors such as surgeons’ experience [ 22 ], abdominal repair [ 16 ], bladder catheterization time [ 23 ], and postoperative infection [ 18 ] were also examined as contributing factors to obstetric fistula repair failure.…”

Vesicovaginal Fistula Post Caesarean Hysterectomy

“…The fundamental treatment principles for VVF repair (adequate exposure, tension-free approximation of the fistula edges, non-overlapping suture lines, good homeostasis, watertight closure and adequate postoperative bladder drainage) can be achieved through both, vaginal and abdominal route, depending upon the surgical experience. 4 The first repair has the highest success rate in VVF, and the best approach is probably the one in which the surgeon is most experienced. Surgical approach is the most commonly preferred for affected women and the success rate varies between 75%-95% in literature.…”

“…2 The success rate has been associated with the etiology of the fistula, site of the fistula, size of the fistula and number of previous failed attempts at repair. 4…”