Naveed Iqbal, Kamran Bhatti, Muhammad Saleem.
Conventional repair of vesicivaginal fistula.
J Allama Iqbal Med Coll Jan ;7(4):35-9.

Object: - To asses the efficacy & complications of the conventional repair of vesicovaginal fistula. Place of study: - This study was conducted in the Department of Urology & Renal Transplantation Jinnah Hospital, Lahore from Jan 2000 to Dec 2004. Study design: - Descriptive case series report Material & Method: - We retrospectively reviewed 33 patients identified with vesicovaginal fistula (VVF) Jinnah Hospital, Lahore from Jan 2000 to Dec 2004. Infra trigonal & supratrigonal VVF were repaired transvaginally & tran abdominally respectively. In patients with recurrent fistula, an omental patch was interposed between bladder and vaginal wall. Results: - We performed a total of 33 fistula repairs. This includes 29 primary repair and four repairs of recurrent fistula. The mean age was 24 years. The common causes of fistula were obstructed labor in 16 (49%) patients, post hysterectomy in 9 (27%) patients, cesarean section in 6(18%) patients and forceps delivery in two (6%) patients. In two patients fistula was close to ureteral orifice, the ureter was dissected & implanted into dome of bladder. Fistula size varied from 1.5cm to 5cm. The mean diameter was 2cm. Twelve patients were infratigonal, with bladder neck and proximal urethral involvement in two patients. Remaining twenty-one patients were supra trigonal. Via vaginal approach, all fistulas were closed successfully. One failure occurred at fifth postoperative day following primary repair with 4 cm size fistula. This fistula also involved the cervix. The failure rate in recurrent fistula was 0 %. The postoperative complications were failure of repair in one patient; wound infection in three patients, temporary unstable bladder in four patients. Stress incontinence in one patient of proximal urethral repair. Conclusion: - Patients with vesico-vaginal fistula should be referred to center with special interest in this type of repair. The final success depends upon surgeon clinical experience, surgical judgment and repair technique.

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