Publication:

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

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.