Review of 10 Cases of Vesico - Vaginal Fistulae
                     910 
REVIEW OF 10 CASES OF VESICO -VAGINAL FISTULAE 
J. J. lOsition of peritoneal graft was done in those post 
hysterectomy. Whereas a layered vaginal closure of the fistula were performed 
for fistulae following obstetric trauma. The fistula repair was successful in all. 
INTRODUCTION range between 65% and 95%. 
The incidence and prevalence of 
vesico-vaginal fistulae remains the same MATERIALS AND METHODS 
over the decades but the etiology shows 10 patients were referred with 
a changing pattern especially in the complaints oflcaking of urine pervaginum 
developed countries. But V-V-F resulting and were diagnosed as V-V-F, at Sir J.J. 
from prolonged obstructed labour remains Group of Hospitals, Bombay. Four of 
a major problem in developing countries these patients had developed V-V-F post 
like ours. For many years surgical closure total abdominal hysterectomy and the 
of the fistula was almost impossible, but other 6 followed obstetric trauma. 
now with good peri-operative care, asepsis, Routine speculum examination, 3 
antibiotics and continuous suprapubic swab test & cystoscopy confirmed the 
bladder drainage, closure rates today diagnosis, size, site, number of the fistulae. 
Besides routine prc.-operative investi-
Dept. of Obst. & Gyn. J. J. 1/ospita/, Bombay. 
Accepted for Publication 14.12.94 gations, urine culture-sensitivity and 011 
REVIEW OF 10 CASES OF VESICO - VAGINAL FISTULAE 911 
excretory urography were carried out. (3) Achieving hemostasis. 
3-0 Vicryl was used for the closure of ( 4) Ensuring continuous bladder drain-
the fistulae. Post operatively both age in post-operative period. 
suprapubic and urethral indwelling bladder Udeh (1985) described a simple 
catheters were placed. method of repairing V-V-F through an 
anterior abdominal approach. 
RESULTS Kursh et al (1988) suggested that 
Of the 4 patients following gynecologic majority of patients with V-V-F had an 
surgery, 3 presented with high vesico- unrecognised injury to the bladder result-
vaginal fistula with failed primary abdomi- ing in urinary extravasation. It is suggested 
- nal repair, 1 presented with high multiple that patients with severe abdominal pain, 
vesico-vaginal fistulae juxtaureteric. distension, paralytic ileus, hematuria or 
All cases with post hysterectomy fis- symptoms of severe irritability of the 
tulae were high and complex in nature and bladder after abdominal hysterectomy be 
being supratrigonal, transperitoneal, investigated early for a possible bladder 
transvesical repair with interposition · of injury. 
peritoneal graft was performed. Vernet (1989) presented a new proce-
Of the 6 patients following obst~tric dure for vesical autoplasty for treatment 
trauma, 5 had low V-V-F while in one of complex V-V-F. A flap is obtained 
case, the fistulous opening involved the from the postero-superior bladder wall 
bladder neck and proximal half of the that slides down to cover large lesions, 
urethra. All cases resulted from even in low capacity reservoirs. 
prolonged obstructed labour. 4 of the Falandry Let al (1990) used a pedicled 
patients had assisted vaginal deliveries, muscle fat flap of the labia majora in the 
while the remaining 2 were delivered by treatment of complex V-V-F. 
LSCS. Enzelsbcrger and Gitsch (1991) 
Transvaginal layered closure was per- successfully repaired 41 V-V-F according 
formed, in addition, Martius graft with to Chassar Moir's method. 
reconstruction of urethra was performed Tancer (1992) put forward his obser-
for the fistula involving the bladder neck vations on prevention and management of 
and proximal urethra. V-V-F after total hysterectomy. Sugges-
tions to avoid injury to the bladder during 
DISCUSSION abdominal total hysterectomy include 
Our key to success to the operative usc of a two way indwelling catheter, when 
procedure with a cent per cent primary risk factors are present, use of sharp 
closure rate was :- dissection to isolate the bladder, use of 
(1) Proper pre-operative assessment extraperitoneal cystotomy when dissection 
for a particular approach. is difficult, filling the bladder when injury 
(2) Adequate mobilisation and separa- is suspected and repair of an overt 
tion of bladder and vagina allowing bladder injury only after mobilization of 
closure in separate planes. the injured area. 
912 
JOURNAL OF OBSTETRICS AND GYNAECOLOGY OF INDIA 
Elkins (1994) reviewed 100 operations surgeons to address the V-V-F problem. 
of obstetric V-V-F in 82 patients. He 
stated that basic principles of fistula REFERENCES 
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CONCLUSION 
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