The management of vesicovaginal fistula.

Objective: To document our experience with management of Vesicovaginal Fistula Study Design: Case Series Study Place and Duration: Dept of Urology, DHQ hospital, Rawalpindi from 2005 to 2010 Materials and Methods: Nineteen cases of urogenital fistula developing after delivery, hysterectomy, and obstetric procedures were treated. Depending on site, size, etiology and associated anomalies, fistulas were repaired through vaginal or transabdominal route. Results: The most common etiology was abdominal hysterectomy for benign conditions in 10 (53%) patients. Second most common cause was obstructed labor in 8 (42%) patients while cesarean section was the cause in 1 (5%) patient. Spontaneous closure occurred in 1 case of vesicovaginal fistula. Eighteen patients (95%) were managed surgically. In 15 (83%) patients fistulas were repaired through abdominal approach. Out of these 15 patients extraperitoneal transvesical technique was used in 11 while retrovesical (O'Connor) technique was used in 4 patients. Ureteric reimplantation required in two patients. In 3 (17%) patients fistula was repaired through vaginal approach. There was no mortality following operative procedures. Our success rate was 95%. Conclusion: Any vesicovaginal fistulas irrespective of their size if easily accessible should be repaired transvaginally. High lying small fistula repaired through transvesical and large fistula through retrovesical approach without interposition of omentum or peritoneum gave excellent results.