Urogenital fistulae: changing trends and personal experience of 46 cases

Abstract

A retrospective study of 46 patients with different types of urogenital fistulae treated by the author during the period from January 1997 to December 2006 is presented. Twenty-two (48%) cases had a vesicovaginal fistula of which 16 (73%) were repaired vaginally and 6 (27%) were repaired abdominally. The remaining fistulae were as follows: 14 (30%) unilateral ureterovaginal fistulae, 6 (13%) ureterovesicovaginal fistulae (one bilateral), and 4 (9%) vesicouterine fistulae. All were repaired abdominally except for one patient with ureterovesicovaginal fistula needing continent urinary diversion using Mainz type II pouch. All fistulae were iatrogenic except one case (2%) which was due to neglected obstructed labor. The iatrogenic causes were gynecologically related in 26 (57%) patients and obstetrically related in 19 (41%) cases. There were two (9%) failed repairs in the vesicovaginal cases, one in each group, and both were salvaged by a secondary surgery. In view of this selected retrospective study and in association with other reports, it seems that with the improvement in the basic health-care services in Egypt, there is a change in the etiology of urogenital fistulae with the vast majority being physician related and no more related to neglected obstructed labor. Such shortcoming should be addressed in the current gynecological surgery training and residency programs.

Experience of our surgery in iatrogenic vesicovaginal fistulas

“…A double J catheter was placed near the mouth of the fistula in trigonal fistulas. Four patients with a fistula size greater than 10 mm and supratrigonal Mean size of the fistulas (mm) 15 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) were repaired abdominally and an omental flap interposition was made. The other four patients with a fistula size less than 10 mm and supratrigonal were repaired abdominally and a layered closure was made without omental flap interposition ( Table 3).…”

“…Transvaginal or transabdominal approaches were preferred as an operation technique. In the transvesical approach, layered closure with or without omental flap interposition (O'Conor technique) was used (11)(12)(13). Abdominal incision was made vertically, the bladder was mobilized widely from the underlying vagina and uterus to the level of the fistula while avoiding from ureter orifice, and the fistula tract was excised circumscribely from the living tissue margin.…”

Urinary Tract Injuries in Low-Resource Settings

“…A group of surgeons with experience both from Turkey and Niger found gynecologic surgery to be the main cause of fistula in the former country and obstetric complications in the latter (8). A change during the later decades from a mainly obstetric to a mainly iatrogenic etiology has been reported from some developing countries (9,10). The quality of obstetric care and surgical skills are important factors for this development.…”

Repair of vesicovaginal fistula by the transabdominal route: outcome at a north Indian tertiary hospital

“…It creates high psychological morbidity and causes social embarrassment to the patient [1]. The abdominal route of VVF repair is indicated in patients with high-up supratrigonal fistulae, VVF associated with ureterovaginal fistula, VVF with lower ureteric stricture, ureteric orifice at the margin of fistula, multiple failed vaginal repair with vaginal shortening and stenosis, radiation fistula, small-capacity bladder requiring augmentation, inability to place the patient in lithotomy position, or surgeon's preference [1][2][3][4][5][6]. The advantages of abdominal repair are simultaneous ureteric reconstruction or bladder augmentation and/or placement of interposition flap such as omentum, peritoneal flap, or tinea epiploicae of sigmoid colon [7][8][9][10].…”

“…The advantages of abdominal repair are simultaneous ureteric reconstruction or bladder augmentation and/or placement of interposition flap such as omentum, peritoneal flap, or tinea epiploicae of sigmoid colon [7][8][9][10]. The disadvantages of abdominal repair are laparotomy causing increased morbidity, pain and scar, bleeding requiring transfusion, comparatively longer operating time, and/or prolonged hospital stay when compared to transvaginal repair [4][5][6]. Herein, we present our experience of transabdominal repair of VVF and its outcome.…”