The 11 Years-Experience in Vesicovaginal Fistula Management
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Abstract
Objective: To explore the selective use of intraoperative cystoscopy/dye test and treatment options for Vesico Vaginal fistula (VVF) in our institute.
Materials and Methods: From March 2002 to March 2013, thirty one patients of VVF were admitted in the Department of urology in our institute. 27 patients were repaired by transabdominal route while as 4 patients were managed conservatively. Out of the 27 patients, 19, 3, and 5 patients were operated by open, laparoscopic, and Robotic assisted laparoscopic repair respectively. Student’s t-test and Chi-square tests were used to evaluate the data. A p < 0.05 was taken as statistically significant.
Results: Most common aetiology was hysterectomy for benign conditions (80.06%). Most of VVF were supratrigonal in location (n=23) and 27 of the 31 VVFs were repaired by transabdominal route by standard O’Conor technique with omental interposition. A success rate of 96.29% was achieved after first repair by transabdominal route (p < 0.0001). Four patients with small intraoperative injury (< 5 mm) which were detected on intraoperative cystoscopy and dye test and were managed by Bilateral ureteric catheterization with 100% success (p = 0.005) at 6 weeks.
Conclusion: VVF resulting from difficult hysterectomy can be prevented by meticulous pelvic dissection with high anticipation of bladder injury. Use of intraoperative cystoscopy or methylene blue dye in bladder recognizes injury at the earliest and allows intraoperative repair which is almost always successful. Also robotic assistance to laparoscopy should be preferred when available due to its minimally invasive nature and advanced degree of freedom which makes complex suturing very easy especially in narrow pelvic cavity.
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References
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