A 12-Year Experience in the Surgical Management of Vesicovaginal Fistulae

MH Kam, YH Tan, MYC Wong
Correspondence: M Y C Wong, gurwyc@sgh.com.sg

ABSTRACT
Introduction Vesicovaginal fistulae are largely iatrogenic and represent therapeutic dilemmas in surgical approach and timing of repairs.
Aim We have reviewed our surgical management of vesicovaginal fistulae over a 12-year period to determine whether the outcome is dependent on surgical approach and timing of repair.
Patients and Methods From January 1990 to September 2001, 23 patients were referred to our department of whom 20 have retrievable records. Fourteen of these 20 patients had gynaecological operations as the primary cause for their fistulas whilst the remaining six had varied causes ranging from forceps delivery to recurrent pelvic malignancies.
Results Of 20 patients, four underwent transvaginal repair, seven transvesical repair, eight supravesical repair and one required an ileal conduit diversion. There was an 85% success after first repair with only three fistula recurrences, two of whom underwent a successful second repair and one was treated conservatively and successfully with urethral catheterisation. There were no further recurrences at mean follow-up of 23 months for our cohort. Earlier repair seemed to be associated with a higher recurrence rate (33% of six patients within six weeks) compared with delayed operations (7% of remaining 14 operated after six weeks).
Conclusion Vesicovaginal fistulae can be successfully managed surgically. Although the type of approach did not affect outcome, the timing of the repair may affect the success of the operation.

Keywords: Vesicovaginal, fistula, genitourinary, iatrogenic, surgical management
Singapore Med J 2003; 44(4): 181-184