Abstract
Introduction: Although most of vesicovaginal fistulas (VVF) are iatrogenic, they can also occur
as a result of congenital anomalies, neoplastic changes, and complications of radiotherapy.
In rural areas, the obstructed labor may lead to the development of VVF. However,
the most common cause of VVF in developed areas is iatrogenic damage of the bladder
tissue.
Aim: To confirm that the immediate repair of iatrogenic urinary bladder injures during
obstetric or gynecological surgeries prevents VVF formation, and to identify optimal
time and outcome of surgical techniques of VVF repair.
Patients & Methods: Prospective study was carried over 9 years and included 95 patients. These patients
were divided into two groups; one group underwent immediate intra-operative repair
of urinary bladder injuries (n=76), while other group presented with VVF and underwent
either reconstructive or urinary diversion surgeries on elective bases (n=19).
Results: The mean age of 19 cases having VVF was 29.4 ± 8.4 years. One case was missed and
other 18 cases underwent abdominal repair (n=8), vaginal repair (n=5) and permanent
urinary diversion (n=5). The time of repair ranged from 2 day to 7 months after detection
of VVF. The success rate of post-surgical VVF repair was 92.3%.
Conclusion: Immediate repair of urinary bladder injuries during obstetric or gynecological surgeries
prevents development of VVF. Post-surgical VVF repair can be done in first post-operative
days before inflammatory changes takes place. The result of VVF repair depends on
the experience of the surgeon rather than the used surgical techniques.
Key-words:
Abdominal repair - vaginal repair - Vesicovaginal fistula
