ETIOLOGY AND OUTCOME OF VESICOVAGINAL FISTULAE SURGICAL REPAIR, AN EXPERIENCE OF 58 CASES AT INSTITUTE OF KIDNEY DISEASES HAYATABAD, PESHAWAR

ABSTRACT
Objective: To find out the etiology and outcome of surgical repair of Vesicovaginal Fistula (VVF) in patients presenting
to Institute of Kidney Diseases Hayatabad Peshawar.
Methodology: This descriptive study was conducted at Institute of Kidney Diseases Hayatabad Medical complex Hayatabad
Peshawar from January 2011 to December 2017. A total of 58 patients diagnosed as having VVF were admitted
either through OPD or emergency were included in the study. Patients having VVF due to malignancy or radiotherapy
were excluded from the study. After taking proper history, clinical assessment, routine investigations and informed
consent, patient’s data was recorded on a structured proforma. Cystoscopy and vaginal examination were performed.
After surgical repair the etiology of VVF and outcome of repair was recorded.
Results: This study included a total of 58 patients aged 18 - 56 years. In 39 (67%) patients, the cause of VVF was
iatrogenic injury during hysterectomy while in 19 (33%) patients, it was due to obstetric injury. In 45 (78%) patients,
the fistula was supra-trigonal which was operated through trans-abdominal approach while in 13 (22%) patients, it
was trigonal or infra-trigonal and was operated through vaginal approach. There was urine leakage in 3 cases of post
transabdominal repair and in one case of vaginal repair which were repaired on a second attempt. The success rate
of abdominal repair was (42) 93.3% in 45 patients and of vaginal repair (12) 92.3% in 13 patients.
Conclusions: Iatrogenic injury during hysterectomy and obstetric injury are the commonest causes of VVF and there
is high success rate of repair, if expert hands employ appropriate techniques.
Key words: Urinary incontinence, Vesicovaginal fistula, Transabdominal repair, Trans-vaginal repair