Management of Female Urogenital Fistulae in Tertiary Care Hospital in Pakistan

ABSTRACT

Introduction and Objectives: Urogenital fistulae in females, when acquired after surgery or obstetric trauma, are associated with significant morbidity and dreadful social and psychological consequences. Successful management of these fistulae demands a high level of skills as well as adherence to basic surgical principles. We review the management of urogenital fistulae at Shifa International Hospital, Islamabad, Pakistan.

Methods: The charts of patients operated for vesicovaginal, ureterovaginal, and vesico/uretero uterine fistula from 2001 to 2008 were reviewed. The following variables were recorded: age of the patient, cause, type and number of fistula, duration between injury and repair, history, the number and outcome of previous repair, surgical approach/technique performed, the outcome of surgical repair in terms of urine incontinence, and postoperative complications.

Results: Nineteen patients with a mean age of 37 years (range: 25 to 51 years) underwent surgical repair of urinary fistulae. Five patients had recurrent fistula after failure of prior repair somewhere else. Thirteen patients had vesicovaginal fistula (VVF) alone, 2 patients had ureterovaginal fistula (UVF) alone, 2 patients had VVF and UVF, 1 patient with vesicouterine fistula (VUF), and 1 patient had uretero-uterine fistula (UUF). Ten patients developed fistula after abdominal hysterectomy for benign conditions, 3 patients developed fistula after a C-section, 3 patients developed fistula after prolonged obstructed labour, and 3 patients developed fistula after obstructed labour and a C-section. Fourteen patients underwent transvesical repair and 1 patient had transvaginal repair of fistula. Ureteric reimplantation was done in 6 patients. Omentum was interposed in 7 cases, peritoneum in 2 patients, and pelvic fascia in 1 patient. No tissue was interposed in 5 cases. Early complications included wound infection (3 patients), pelvic abscess (2 patients), small pelvic collection (1 patient), and superficial thrombophlebitis in the right leg mimicking DVT (1 patient). Late complications included incisional hernia in 3 patients, lower urinary tract symptoms (LUTS) in 3 patients, and recurrent urinary tract infection (UTI) in 1 patient. Post-coital pain occured in 1 patient. The duration of follow-up ranged from 1 month to 3 years. The success rate in terms of relief from urinary incontinence and lack of recurrence was 100% in our series.

Conclusions: The management of acquired urogenital fistulae consists of proper evaluation, the correction of any focus of infection, nutritional deficiencies prior to surgery, planning surgery at the proper time when local inflammation settles, and adherence to meticulous surgical techniques. High success rates can be achieved by observing the basic principles of surgical techniques.

KEYWORDS: Vesicovaginal fistula (VVF), ureterovaginal fistula (UVF), vesico uterine fistula (VUF).

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