Mir Alam Jan, Anayat Ullah, Sarhad Khan.
Management of Vesicovaginal Fistula: An Experience with 32 Cases.
Ann Pak Inst Med Sci Jan ;8(3):180-3.

Objective: To document our experience of the repair of vesicovaginal fistula (VVF) with special reference to surgical approach. Study Design: Case series study Place and duration: Department of Urology and Renal Transplantation, Institute of Kidney Diseases, Hayatabad Medical Complex (HMC), Peshawar and Urology Department, Lady Reading Hospital, Peshawar over a period of five years from January 2006 to December 2010. Materials and Methods: The study included VVF patients who underwent operative treatment during the study period. Fistulas were divided into two simple and complex types depending on the site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route while complex VVFs were managed through transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms. Results: There were 32 patients with VVF. The mean age was 35 ± 07 years. Twenty patients (61.5%) had simple fistulas while 12 (38.5%) patients had complex fistulas. The most common etiology was obstetric trauma in 16 (50%) patients, followed by pelvic Surgery in 13 (40.62 %) patients. Twenty (62.5%) patients were managed by transvaginal route, of which 3 had supratrigonal and 17 trigonal fistulas. Twelve (37.5%) patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. The success rate was 90.62%. At a mean follow-up of three years, 29 women were sexually active, of these 07 (21.87%) complained of mild to moderate dyspareunia which gradually decreased over time. Conclusion: The approach for the management of VVF has to be individualized depending on the local findings. Most of the simple fistulas irrespective of their locations are easily accessible transvaginally. The transvaginal approach is less invasive and achieves comparable success rates. We recommend transabdominal approach for complex fistula, which allows simultaneous correction of associated anomaly.

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