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Shrestha, Ranjana, Aruna Karki, Ganesh Dangal, Hema Pradhan, Kabin Bhattachan, Rekha Poudel, Nishma Bajracharya, and Kenusha Devi Tiwari. "Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital." Nepal Journal of Obstetrics and Gynaecology 13, no. 2 (November 18, 2018): 19–22. http://dx.doi.org/10.3126/njog.v13i2.21699.
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Aims: Vesico-vaginal fistula (VVF) is an abnormal fistulous communication between the bladder and/or urethra and the vagina that allows continuous involuntary discharge of urine into the vaginal vault affecting patients’ medical, physical, mental, social and sexual life. The aim of this study was to review and deliver a profile, their demography and outcome in the early phase of fistula surgery performed in our institute.
Methods: This was a retrospective study of 222 patients who underwent fistula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The fistula were classified according to Goh`s system. Patients’ demography, obstetric characteristics and fistula repair outcomes were reviewed. The primary outcome was in terms of urinary continence.
Results: A total of 222 women aged between 10 to 65 years with a mean age of 31.4 were included. Majority of the patients had fistula due to obstetrical cause, contributing 58% (n=127) and in 42 % (n=95) of patients had fistula of gynecological etiology. Most of the patients had fistula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh’s classification. Among 127 fistulas repaired of obstetric etiology100 (78.7%) patients and 85 (89.4%) out of 95 fistula patients of gynecological cause were continent and dry.
Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric fistula, however iatrogenic fistula was also becoming common. Majority of our cases had successful outcome with some degree of stress in some patients.
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Pradhan, Hema Kumari, Ganesh Dangal, Aruna Karki, Ranjana Shrestha, Kabin Bhattachan, Amit Mani Upadhyay, Rekha Poudel, Nishma Bajracharya, Kenusha Devi Tiwari, and Sonu Bharati. "Clinical Profile of Urogenital Fistula in Kathmandu Model Hospital." Journal of Nepal Health Research Council 18, no. 2 (September 7, 2020): 210–13. http://dx.doi.org/10.33314/jnhrc.v18i2.2376.
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Background: To determine the causes of fistula and to share our experience in treating urogenital fistula and its surgical outcome.Methods: This was a retrospective study done at Kathmandu Model Hospital from January 2014 to June 2019 including 261 patients operated for fistula. The patients were analyzed for age, type of fistula, cause, treatment and surgical outcome.Results: Out of 261 patients operated, 59.38% cases had obstetric fistula, 38.69% had iatrogenic and 1.92% had traumatic fistula. Most of the patients with obstetric fistula were between 21 to 25 years of age whereas iatrogenic fistulae were between 46-50 years of age. The majority (54.84%) of obstetric fistulae were vesicovaginal fistula (54.84%) while the commonest type (77.36%) of iatrogenic fistula was vault fistula after abdominal hysterectomy. Conclusions: This study showed that obstructed and neglected labor was still the major cause of genitourinary fistula in Nepal nevertheless iatrogenic fistula following pelvic surgery is increasing. The surgical outcome of repair of fistula was good.Keywords: Latrogenic fistula, obstructed labour, urogenital fistula.
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Gele, Abdi A., Abdulwahab M. Salad, Liban H. Jimale, Prabhjot Kour, Berit Austveg, and Bernadette Kumar. "Relying on Visiting Foreign Doctors for Fistula Repair: The Profile of Women Attending Fistula Repair Surgery in Somalia." Obstetrics and Gynecology International 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/6069124.
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Obstetric fistula is treatable by surgery, although access is usually limited, particularly in the context of conflict. This study examines the profile of women attending fistula repair surgery in three hospitals in Somalia. A cross-sectional study was conducted in Somalia from August to September 2016. Structured questionnaires were administered to 81 women who registered for fistula repair surgery in the Garowe, Daynile, and Kismayo General Hospitals in Somalia. Findings revealed that 70.4% of the study participants reported obstetric labor as the cause of their fistula, and 29.6% reported iatrogenic causes. Regarding the waiting time for the repair surgery, 45% waited for the surgery for over one year, while the rest received the surgery within a year. The study suggests that training for fistula surgery has to be provided for healthcare professionals in Somalia, fistula centers should be established, and access to these facilities has to be guaranteed for all patients who need these services.
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Dangal, G., K. Thapa, K. Yangzom, and A. Karki. "Obstetric Fistula in the Developing World: An Agonising Tragedy." Nepal Journal of Obstetrics and Gynaecology 8, no. 2 (February 5, 2014): 5–15. http://dx.doi.org/10.3126/njog.v8i2.9759.
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Obstetric fistulae is the most tragic of preventable childbirth complications in the developing world, as affected women are often abandoned by their husbands and family, and forced to live in shame. They occur almost entirely in the developing world and their incidence is poorly studied. Their management requires accurate diagnosis, sufficient pre-operative work-up, fine surgery following standard surgical repair steps and principles by skilled surgeons, specialised post-op care, and follow-up. As obstetric fistula is a serious preventable public health issue in developing countries, national and international organizations should launch a campaign to end fistula by increasing the resources and skilled staff available locally to treat obstetric fistula for improving the lives of women currently living with this condition. Moreover, effective preventive strategies for obstetric fistula such as better education to women and provision of improved obstetric care and searching for the best approaches to both prevention and treatment should be the priority. The materials published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2013 have been utilized to prepare this paper.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 5-15 DOI: http://dx.doi.org/10.3126/njog.v8i2.9759
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Danys, Donatas, Narimantas Evaldas Samalavičius, Gytis Žaldokas, and Edgaras Smolskas. "Rektovaginalinių fistulių gydymas naudojant Martius lopą: klinikinis atvejis." Lietuvos chirurgija 13, no. 2 (January 1, 2014): 118–22. http://dx.doi.org/10.15388/lietchirur.2014.2.3081.
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ĮžangaRektovaginalinė fistulė yra apibūdinama kaip epitelizuota nenormali jungtis tarp tiesiosios žarnos ir makšties. Ši fistulė sudaro apie 5 % visų tiesiosios žarnos ir išangės fistulių. Dažniausios rektovaginalinės fistulės atsiradimo priežastys yra gimdymotraumos, lėtinės uždegiminės žarnų ligos, žema priekinė tiesiosios žarnos rezekcija, hemorojinių mazgų ir dubens srities chirurgija. Gydymo galimybių yra daug: endorektalinis, transvaginalinis ar transperinealinis uždarymas, pažeistos vietos rezekcija,gydymas autologinėmis kamieninėmis ląstelėmis, fistulės drenavimas ar graciloplastika. Esant žemai rektovaginalinei fistulei, Martius lopas yra tinkamas pasirinkimas dėl gerų pooperacinių rezultatų bei mažo donorinės vietos kosmetinio irfunkcinio pažeidimo.Klinikinis atvejisPacientei buvo diagnozuotas žemas tiesiosios žarnos navikas ir po neoadjuvantinės chemoradioterapijos atlikta priekinė tiesiosios žarnos rezekcija bei suformuota prevencinė ileostoma. Tos pačios hospitalizacijos metu ileostoma uždaryta. Pooperaciniu laikotarpiu atsirado rektovaginalinė fistulė. Tuomet pacientė gavo adjuvantinę chemoterapiją. Po jos atlikta graciloplastika ir suformuota ileostoma. Po dviejų mėnesių rektovaginalinė fistulė vėl pasikartojo. Dėl rektovaginalinės fistulėsrecidyvo alikta Martius lopo operacija. Praėjus mėnesiui po operacijos, apžiūrėdamas pacientę chirurgas rektovaginalinės fistulės recidyvo nerado.IšvadosMartius lopo technika naudojant riebalinio audinio lopą yra tinkamas pasirinkimas gydant rektovaginalines fistules.Reikšminiai žodžiai: rektovaginalinė fistulė, Martius lopasThe Martius flap for repair of low rectovaginal fistula: a case reportDonatas Danys, Narimantas Evaldas Samalavičius, Gytis Žaldokas, Edgaras Smolskas BackgroundRectovaginal fistula is defined as an epitheliumlined abnormal communication between the rectum and the vagina. It is reported to represent approximately 5% of all anorectal fistulas. The most common causes of rectovaginal fistulas are obstetric traumas, chronic inflammatory bowel diseases, low anterior rectal resection, hemorrhoid and pelvic surgery. There are many treatment options, such as endorectal, transvaginal or transperineal closure, resection of the affected part, treatment with autologous stem cells, seton drainage or graciloplasty. For low fistulas, the Martius flap is referred to as an excellent choice of tissue transfer with no functional and low cosmetic deficit of the donor site.Case reportA patient was diagnosed with low rectal cancer and after neoadjuvantive chemoradiotherapy underwent anterior rectal resection. Preventive ileostomy was made. Later, due to the fluent postoperative progress, ileostomy closure was performed. In the postoperative period, a rectovaginal fistula occurred. Then, the patient was given adjuvantive chemotherapy. After that, graciloplasty for the rectovaginal fistula and ileostomy were performed. After two months, a rectovaginal fistula occurred again, and the Martius flap repair was performed.ConclusionThe Martius flap technique using a fat pad flap is a decent choice for low rectovaginal fistulas. A well vascularised interposition flap between the vagina and the rectum gives good results.Key words: rectovaginal fistula, the Martius flap
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Danys, Donatas, Narimantas Evaldas Samalavičius, Gytis Žaldokas, and Edgaras Smolskas. "Rektovaginalinių fistulių gydymas naudojant Martius lopą: klinikinis atvejis." Lietuvos chirurgija 13, no. 2 (January 1, 2014): 118–22. http://dx.doi.org/10.15388/lietchirur.2014.3081.
Full textAbstract:
ĮžangaRektovaginalinė fistulė yra apibūdinama kaip epitelizuota nenormali jungtis tarp tiesiosios žarnos ir makšties. Ši fistulė sudaro apie 5 % visų tiesiosios žarnos ir išangės fistulių. Dažniausios rektovaginalinės fistulės atsiradimo priežastys yra gimdymotraumos, lėtinės uždegiminės žarnų ligos, žema priekinė tiesiosios žarnos rezekcija, hemorojinių mazgų ir dubens srities chirurgija. Gydymo galimybių yra daug: endorektalinis, transvaginalinis ar transperinealinis uždarymas, pažeistos vietos rezekcija,gydymas autologinėmis kamieninėmis ląstelėmis, fistulės drenavimas ar graciloplastika. Esant žemai rektovaginalinei fistulei, Martius lopas yra tinkamas pasirinkimas dėl gerų pooperacinių rezultatų bei mažo donorinės vietos kosmetinio irfunkcinio pažeidimo.Klinikinis atvejisPacientei buvo diagnozuotas žemas tiesiosios žarnos navikas ir po neoadjuvantinės chemoradioterapijos atlikta priekinė tiesiosios žarnos rezekcija bei suformuota prevencinė ileostoma. Tos pačios hospitalizacijos metu ileostoma uždaryta. Pooperaciniu laikotarpiu atsirado rektovaginalinė fistulė. Tuomet pacientė gavo adjuvantinę chemoterapiją. Po jos atlikta graciloplastika ir suformuota ileostoma. Po dviejų mėnesių rektovaginalinė fistulė vėl pasikartojo. Dėl rektovaginalinės fistulėsrecidyvo alikta Martius lopo operacija. Praėjus mėnesiui po operacijos, apžiūrėdamas pacientę chirurgas rektovaginalinės fistulės recidyvo nerado.IšvadosMartius lopo technika naudojant riebalinio audinio lopą yra tinkamas pasirinkimas gydant rektovaginalines fistules.Reikšminiai žodžiai: rektovaginalinė fistulė, Martius lopasThe Martius flap for repair of low rectovaginal fistula: a case reportDonatas Danys, Narimantas Evaldas Samalavičius, Gytis Žaldokas, Edgaras Smolskas BackgroundRectovaginal fistula is defined as an epitheliumlined abnormal communication between the rectum and the vagina. It is reported to represent approximately 5% of all anorectal fistulas. The most common causes of rectovaginal fistulas are obstetric traumas, chronic inflammatory bowel diseases, low anterior rectal resection, hemorrhoid and pelvic surgery. There are many treatment options, such as endorectal, transvaginal or transperineal closure, resection of the affected part, treatment with autologous stem cells, seton drainage or graciloplasty. For low fistulas, the Martius flap is referred to as an excellent choice of tissue transfer with no functional and low cosmetic deficit of the donor site.Case reportA patient was diagnosed with low rectal cancer and after neoadjuvantive chemoradiotherapy underwent anterior rectal resection. Preventive ileostomy was made. Later, due to the fluent postoperative progress, ileostomy closure was performed. In the postoperative period, a rectovaginal fistula occurred. Then, the patient was given adjuvantive chemotherapy. After that, graciloplasty for the rectovaginal fistula and ileostomy were performed. After two months, a rectovaginal fistula occurred again, and the Martius flap repair was performed.ConclusionThe Martius flap technique using a fat pad flap is a decent choice for low rectovaginal fistulas. A well vascularised interposition flap between the vagina and the rectum gives good results.Key words: rectovaginal fistula, the Martius flap
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Begum, SN. "Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh." Journal of Bangladesh College of Physicians and Surgeons 29, no. 4 (July 21, 2012): 207–12. http://dx.doi.org/10.3329/jbcps.v29i4.11328.
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Genitourinary fistula is one of the most dreadful complications encountered in obstetrics and gynaecology and constitute a major surgical challenge for the urogynecologist. With advanced obstetric care, this fistula is rare in industrialized world but it is still a major health problem in underdeveloped countries, particularly in sub- Saharan Africa and Asia including Bangladesh. Victim of fistula become physically cripple, socially outcast, psychologically traumatized. Surgical repair is the definitive cure. A surgeon with adequate training and experience can optimize outcome of surgery by modifying techniques. Repair of vesicovaginal fistula remains a major challenge to surgeon worldwide. Aim of the study was to undertake a baseline evaluation of all genitourinary fistula cases and to share the experience of management of fistula with others. This descriptive study was conducted in the department of Obstetrics and Gynaecology, Sylhet M.A.G. Osmani MedicalCollege Hospital. A total 311 genitourinary fistula cases were admitted and managed here from July 2004 to March 2010. In this study 64.63% of the patients were between 20-35yrs of age (range 18-70yrs), 42.76% were primipara whereas 20.57% were grandmulti. Height was <145cm in 67.84% cases. Majority (80.38%) of the patients were from poor socioeconomic status; 91.63% was housewife, and 89.38% was illiterate. Obstructed labour was responsible for 86.81% of fistula. Vesico-vaginal fistula was the most common (87.46%) type of fistula and 79.43% of fistula was complex in nature. 92.10% had local repair through vaginal approach, labial fat graft was used in 44% cases. In this study out of 242 operation 85.54 %(n-207) had successful repair. Among them 75.61% patient were completely continent. Causes of failure were likely to be due to extensive scarring with loss of tissue, previous failed repair, large size of fistula and in some cases post-operative catheter problem and infection. Fistula is largely a preventable condition. More emphasis should be given on prevention of fistula by increasing community awareness, female education and empowerment, avoiding early marriage, family planning, improved maternity services, timely referral and availability of emergency obstetric care services. DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11328 J Bangladesh Coll Phys Surg 2011; 29: 207-212
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Nahar, N., S. Chaudhury, and M. Zillur Rahman. "Study of Urogenital Fistula in Rajshahi Medical College Hospital." TAJ: Journal of Teachers Association 24, no. 2 (November 28, 2018): 91–94. http://dx.doi.org/10.3329/taj.v24i2.37510.
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This cross-sectional study was carried out in the gynae department of Rajshahi Medical College Hospital during the year January 2005 to December 2011, where 202 patients were studied for obstetric history, previous attempt at repair, the condition of the patient, the route of repair, age, etiological factors, techniques of surgery, socio-economic conditions, as well as treatment & results. Among 202 cases, surgery was done in 136 cases (67.33%). Among them 126 were successful (92.65%) and 10 failed (9.35%). Obstetric fistula results from obstructed labour occur mostly in the first pregnancy in young women. Prevention will include education, communication, transport, health care measures and prevention of early marriage. Awareness for mandatory hospital delivery in high risk pregnancies also can reduce obstetric fistulas. With good pre-operative intra-operative and post operative care and attention to surgical details may cure these affected woman.TAJ 2011; 24(2): 91-94
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Shrestha, Ranjana, Kenusha Devi Tiwari, Ganesh Dangal, Aruna Karki, Hema Pradhan, Kabin Bhattachan, Rekha Poudel, Nishma Bajracharya, and Sonu Bharati. "Pregnancy after Obstetric Fistula: Should It Be Encouraged?" Nepal Journal of Obstetrics and Gynaecology 13, no. 3 (December 31, 2018): 56–58. http://dx.doi.org/10.3126/njog.v13i3.23447.
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Obstetric fistula (OF) is a life-changing morbidity associated with childbirth. It occurs especially after a prolonged obstructed labor and is a major public health problem in the developing countries. The smell of stool and urine leads to the ostracization and rejection of fistula patients by their spouses, families, friends and society in whole. Surgical treatment of fistula is possible. However, this successful outcome of fistula repair surgery is dependent on pre-operative care and the post-operative care such as delaying the commencement of sexual intercourse and delaying conception. Family planning can aid to this. Pregnancy is advised after minimum of 12 months’ post-repair and mode of delivery should be elective cesarean section. Here, we present a case of 23 years’ female, who suffered from obstetric fistula who underwent obstetric fistula repair twice, re-married and conceived after a year with successful elective cesarean delivery.
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Ara, Rowshan, Abu Taher Mohammad Nurul Amin, Md Shadiqul Hoque, and Setara Binte Kasem. "Characteristics and Surgical Success of Patients Presenting for Repair of Genitourinary Fistula in VVF Center of a Tertiary Hospital." Bangladesh Journal of Obstetrics & Gynaecology 31, no. 1 (October 12, 2017): 34–39. http://dx.doi.org/10.3329/bjog.v31i1.34274.
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Objective(s): To carry out a prospective review of patients who had undergone surgical repair of genitourinary fistula to determine patients characteristics and to explore success of surgery in relation to aetilogy of fistula and attempt of surgery.Materials and Methods : This cross-sectional study was carried out in patients attending the Fistula centre in Dhaka Medical College and Hospital (DMCH) from April 27th to July25th, 2013. Out of 47 patients 27 were recruited for this study. Detailed history was taken about socio-demographic character, gestational age, duration of labour, mode of delivery, conduction of labour and foetal outcome. Causes of fistula, information about fistula repair and success rate were noted. Main outcome measures were successful repair and correlation of success with aetiology of fistula, attempt of surgery. Data were analyzed by SPSS package. A p value of <0.5 was considered as significant.Results: Mean age of the patients was 33.73± 10.73 years with a range of 17 to 58 years and mean height was 144.67±3.013cm. Most of the women (66.7%) were from lower social class. The most common fistula 19 (70.37%) was obstetric due to obstructed labour and in 8 (25.93%) cases it was due to consequence of gynaecological surgery. Mean gestational age of the foetus were 38.57±1.409 weeks and duration of labour was 34.83±14.618 hours. Out of 27 patients, 7 had prior fistula repair without success, 4 patients had prior 2 attempts and 3 had previous 3 and 4 attempts. In 21 patients surgical repair was done through vaginal route while 6 required abdominal approach. Local repair was done in 18 (66.67%) cases and grafting was done in 5(18.52%) cases. Fifteen (55.56%) patients had successful repair and success rate was more when it was first attempted (90%) and 20% in repeat attempt but it was statistically significant p<0.05. Success of repair was more when causes of fistula was gynaecological (87.50%) than when it was obstetrical (42.11%), p<0.05.Conclusion: Success of surgery of genitourinary fistula depends upon so many factors. Gynaecological fistula can be repaired more successfully than obstetrical one. First attempt of surgery is the best attempt, so must be done at skilled hand.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 34-39
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Pope, Rachel, Mary Stokes, Roger H. Brown, Chisomo Chalamanda, Larry H. Hollier, and Jeffrey P. Wilkinson. "Plastic Surgery Techniques for the Improvement of Outcomes of Complex Obstetric Fistula Repairs." Nepal Journal of Obstetrics and Gynaecology 13, no. 2 (November 19, 2018): 41–43. http://dx.doi.org/10.3126/njog.v13i2.21735.
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Aims: As part of a larger study on the outcomes of obstetric fistula surgery, a review on patient outcomes when using gracilis muscle and/or Singapore flaps was conducted.
Methods: The database queried includes over 1700 patients. Fifty-six cases were identified having had either a gracilis muscle and or a Singapore flap as part of the repair.
Results: Twenty-one patients had a Singapore flap only. Median age was 26 years (19-55), four had one prior repair and two had two prior repair attempts. Nine cases were Goh type 3 and nine were Goh type 4 indicating urethral involvement. 71% (n=15) were >3 centimeters in diameter. Median estimated blood loss (ebl) was 200 ml and average OR time was 2.5 hours. Median catheter duration 17 days (13-25). 81% (n=17) were dye test negative, with an average pad weight of 19.2 grams. 19 patients had a gracilis muscle flap alone with median age of 43 (23-70). Four had one previous repair, one had four previous repairs. Nine were Goh type 3 and eight were Goh type 4. 70% (n=12) had a fistula >3 cm in diameter and 88% (n=15) had type iii considerations (previous repair attempt, circumferential, or severe scarring). Median ebl was 250 ml and average operative time was two hours and 30 minutes. Median catheter duration was 17 days (14-31). 82% (n=14) had negative dye tests, with average pad weight of 19 grams. 16 patients had both a Singapore and a gracilis. Median age was 31 (15-70), nine were Goh type 3, seven were Goh type 4. 87.5% (n=14) had a fistula that was more than 3 cm in diameter and 87.5% (n=14) were type iii. Median ebl was 300 ml (250-1000 ml), and average operative time was 3 hours and 45 minutes. 81% (n=13) had a negative dye test, with two patients going home positive and returning negative over the course of four months. Average pad weight was 18.9 grams.
Conclusions: For large fistulas with a significant amount of vaginal tissue loss, the Singapore flap is a potential option for improved outcomes. For recurrent cases and those with poor quality tissue, the gracilis muscle may lead to overall improved outcomes. Overall, these techniques are useful for complex obstetric fistula cases where outcomes are generally less favorable. Further prospective studies are needed.
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Pradhan, HK, G. Dhangal, A. Karki, R. Shrestha, and K. Bhattachan. "Experience of Managing Urogenital Fistula." Nepal Journal of Obstetrics and Gynaecology 9, no. 1 (September 28, 2014): 17–20. http://dx.doi.org/10.3126/njog.v9i1.11181.
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Aim: The study was done to review the demography of urogenital fistulae including obstetric fistula (OF) and its surgical outcome in the early phase of fistula surgery and to create awareness about OF. Methods: This was a retrospective study of 47 patients who underwent fistula surgery during the period of January 2012 to May 2014 in Kathmandu Model Hospital, Helping Hand Community Hospital, Camp in Mid-wetern Regional Hospital Surkhet and Hamlin Hospital, Ethiopia. The primary outcome was in terms of urinary continence after 14 days of repair. Results: In the study 70% (n=33) of fistula were due to obstructed labour and 30% (n=14) were due to hysterectomy for gynecological indications. Ninety six percent (n=45) had successful closure of fistula. Seventy seven percent (n=36) were continent after surgery, and 17% (n=8) had some stress incontinence. Conclusions: The study showed obstructed labour was the major cause of OF, however iatrogenic fistula was also becoming common. The success of repair depended on the type, site, size of fistula and urethral length. Majority of our cases had successful closure of fistula with some degree of stress in some patients. DOI: http://dx.doi.org/10.3126/njog.v9i1.11181 NJOG 2014 Jan-Jun; 2(1):17-20
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Biswas, Nrinmoy, Iftikher Mahmood, Sathyanarayan Doraiswamy, and Animesh Biswas. "Genital fistula: Successes, challenges, and way forward in a facility specialization in fistula management in Bangladesh." Nepal Journal of Obstetrics and Gynaecology 14, no. 1 (December 9, 2019): 19–23. http://dx.doi.org/10.3126/njog.v14i1.26622.
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Aims: To explore the prevalence, types of genital fistulas as well as their success, challenges, and way forward on genital fistula in Bangladesh.
Methods: Between October 2017 and September 2018, Hope Hospital identified a total number of 101 genital fistula cases though a community network system in Cox’s Bazar. For each of the patients, detailed case histories and clinical management reports documented, and the data were interpreted using descriptive analysis.
Results: Out of 101 genital fistula cases admitted to the facility, 95.3% (n=96) of cases were obstetric; three cases iatrogenic, and one each traumatic and congenital. The median age of the women was 28 years (range: 18 -73) and the median duration of two years (range: 1 month-53 years). Most of the cases had urinary incontinence (86.1 %, n=85) and 12 and two cases were fecal and mixed type respectively. Vesicovaginal fistula (VVF) repair was performed in most of the cases (78.2%, n=79) while 21.8% (n=22) received recto vaginal fistula (RVF) repair. 90% (n=91) were discharged without complication. The median duration of hospital stay was 16 days (range: 4 -29). The success rate was 86.1% (n=85), and 16 cases advised for repeat surgery. Pre-and post-surgery counselling was provided without rehabilitation or reintegration support.
Conclusions: Facility data in a particular geographic location represents high prevalence of obstetric fistula and lacks rehabilitation and social reintegration support. Further study is essential to draw a complete geographical map for genital fistula in Bangladesh.
Keywords: genital fistula, management, rehabilitation, Bangladesh
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Razzaque, Sharmin, Nazmun Nahar, Sahela Jesmin, and Hasina Akhter. "Aetiological Factors of Urogenital Fistula and the Treatment Outcome of Patients with Urogenital Fistula Admitted in Rajshahi Medical College Hospital, Rajshahi." TAJ: Journal of Teachers Association 29, no. 2 (December 3, 2018): 11–15. http://dx.doi.org/10.3329/taj.v29i2.39101.
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Urogenital fistulas, majority of which are of vesicovaginal fistulas are commonly caused by prolong obstructed labor and is one of the worst complications of childbirth and poor obstetric care. With the advancement of health care delivery system aetiology of urogenital fistula is also changing in our country. The objective of this study is to create awareness about urogenital fistula, to evaluate the aetiology, profile of the patients and outcome of surgical repair in RMCH. It was a cross-sectional type of observational study having descriptive component of a total 68 cases of urogenital fistula admitted in the department of Obstetrics and Gynaecology, RMCH over a period of one year and six months from January 2009 to July 2010. The incidence among patients admitted in Obstetrics and Gynae was 0.45% and among Gynae patient’s incidence was 1.1%. Majority of the patients were young primipara, short stature and malnourished, coming from lower socio-economic condition of rural areas. Obstructed labour 21(30.8%) was the most common cause of urogenital fistula, followed by gynecological surgeries mainly hysterectomies 19 (27.3%), corrosive application 7 (10%) a rare cause but was found in high rate in this study. A total no of 50 patients underwent surgery. Overall success rate was 46 (92%) and functionally failed with a failure in 4 (8%) cases. The etiology urogenital fistula is preventable and all types of urinary fistula can be repair. Improvement in maternity care in rural areas, easy approach to specialist care and better training of staff in instrumental deliveries may help to decrease the incidence of these fistulas.TAJ 2016; 29(2): 11-15
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Umoiyoho, Aniefiok J., Aniekan M. Abasiattai, and Okon E. Akaiso. "Review of obstetric fistulas in a rural hospital in South-South Nigeria." Urogynaecologia 25, no. 1 (November 4, 2011): 7. http://dx.doi.org/10.4081/uij.2011.e7.
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<em>Background</em>. Obstetric fistula is a devastating medical condition associated with adverse social, psychological and reproductive health consequences. This study was carried out to review the pattern of presentation and outcome of patients with obstetric fistulas in a rural health facility in South-South Nigeria. <em>Design and Method</em>. A retrospective review of case notes of 51 patients with obstetric fistula that were managed at the Family Life Center, Mbribit Itam, in Itu, Local Government Area of Akwa Ibom State. <em>Results</em>. During the study period, 51 obstetric fistulas were repaired in the hospital. The ages of the patients ranged from 15 to 50 years with median age of 25.8 years and modal age group of 21-30 years (45.1%). The majority of the patients were of low parity (72.5%), 56.9% had no formal education and 27.5% were traders. Thirty four patients (66.7%) had their fistulas for between 1 and 6 years, 19.6% of the patients had juxta-cervical fistulas, while eight (15.7%) had circumferential loss of the urethra. Thirty-seven (72.5%) of them where unbooked and thus had no antenatal care, while 4 (7.8%) booked and had antenatal care in conventional health facilities. Thirty-four patients (66.7%) remained dry twenty-one days after surgery, thirteen (23.5%) were still wet, while 4 patients (7.8%) had stress incontinence despite repair. <em>Conclusion</em>. Obstetric fistulas are found most commonly among young, poorly educated women of low parity who do not avail themselves of orthodox ANC in our environment. Government, community and religious leaders must make concerted efforts to ensure women obtain formal education and when pregnant, have access to emergency obstetric care even if resident in the rural areas. Government, relevant non-Governmental organisations, community leaders and health workers should through relevant health messages enlighten women in the community about obstetric fistulas and the dangers of delivering in unorthodox health facilities. More medical personnel should be trained as the first attempt at repair is the one that is most likely to succeed.
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Selukar, Dhananjay, Amit Narayan Pothare, Kunal Meshram, Nikhilesh Jibhkate, Vinay Rahangdale, and Shrikant Perka. "A case series of urogenital fistulas." International Surgery Journal 4, no. 5 (April 22, 2017): 1731. http://dx.doi.org/10.18203/2349-2902.isj20171630.
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Background: Urogenital fistula is an abnormal fistulous communication that occurs between the bladder and cervix or uterus; between the ureter and vagina, uterus, or cervix; and between the urethra and vagina. Most cases in developing countries are of obstetric etiology, resulting from prolonged neglected obstructed labour, and around 1–2 per 1000 deliveries may be affected. The majority of UGFs in developed countries are a consequence of gynecological surgery, mainly hysterectomies. Present study focuses on the various presentations and the different modalities of surgeries done for cases of urogenital fistulas at our institute.Methods: A total 19 cases of urogenital fistula were studied in detail as per proforma. Two patients were operated on emergency basis because of early presentation in postoperative period. For others a pre-operative waiting period of 3-6 months was followed after development of fistula. During this period initially bilateral DJ stenting was tried in all patients, in hope of spontaneous closure of fistulas. Two patients whose fistulas closed spontaneously are not subjected to surgery. Rest all cases were managed surgically by standard surgical procedures.Results: Study was conducted between, February 2015 to February 2017. A total 19 patients studied. In 2 patients, fistula healed spontaneously while in 17 patients, surgery was needed. Most common age group affected is 2nd decade of life about 47.36%. In our study gynecological surgeries predominate with 57.89% followed by obstetric cases in 26.31%. Most of patients presented with continues dribbling of urine through vagina with normal voiding pattern in about 78.94% of cases. Overall transabdominal procedures had nearly 100% success rate, mainly because of better dissection, visualization and use of vascularized graft which prevents recurrence. 1 recurrence was seen in transvesical extraperitoneal approach because of undiagnosed another fistulous tract. Ureteric reimplantation was 100% successful in ureterogenital fistulas. Vaginal approach with use of Mortius flap had 75% success rate with 1 recurrence because of flap necrosis. Mean duration of surgery was 120 minutes and mean hospital stay was 8 days..Conclusions: Urogenital fistulas are the most distressing complications of obstetric and gynecological surgeries. Obstetric causes predominate in developing countries while gynecological surgeries predominate in developed countries. Despite the good results of surgical repair, attempt should be focused on the prevention of VVF.
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Mohamed, Adam A., Abiodun O. Ilesanmi, and M. David Dairo. "The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia." Obstetrics and Gynecology International 2018 (September 27, 2018): 1–10. http://dx.doi.org/10.1155/2018/5250843.
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Obstetric fistula is a severe maternal morbidity which can have devastating consequences for a woman’s life and is generally associated with poor obstetric services leading to prolonged obstructed labour. The predisposing factors and consequences of obstetric fistula differ from country to country and from community to community. The World Health Organization estimated that more than 2 million women in sub-Saharan Africa, Asia, the Arab region, Latin America, and the Caribbean are living with the fistula, and some 50,000 to 100,000 new cases develop annually with 30,000–90,000 new cases developing each year in Africa alone. This study aimed at describing and exploring the experiences of women living with obstetric fistulas following corrective surgery in Benadir and Mudug regions, Somalia. Women living with obstetric fistula who had surgical repairs at Daynile and GMC fistula centers and key informants were identified purposively. Twenty-one individual in-depth interviews among women with obstetric fistula and eight key informant interviews were conducted. Thematic analyses were used. Codes were identified, and those codes with similar connections were organized together as to form themes. Detailed reading and rereading of the transcribed interviews were employed in order to achieve and identify themes and categories. Themes, categories, and subcategories illustrating the experiences of women living with obstetric fistula emerged from the thematic analysis of individual in-depth and key informant interviews. These were challenges of living with OBF which include “wounds around genitalia, bad odour, incontinences of urine and feces, stigma, isolation, divorce, powerlessness, dependency, financial constraints, and loss of healthy years” and coping mechanisms which include “withdrawal from the community and improved personal hygiene.” Women with obstetric fistula experience serious health and social consequences which prevents them fulfill social, family, and personal responsibilities. We recommend expansion of BEmONC services to underserved areas, capacity building for local OBF surgeons, and improved media campaign and birth preparedness at community levels.
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Islam, Jawad Ul, Ronald Grainger, Ted McDermott, Robert Flynn, and John Thornhill. "Repair of non-obstetrical vesicovaginal fistula: a 13-year experience of single Irish institution." Urogynaecologia 27, no. 1 (June 4, 2013): 1. http://dx.doi.org/10.4081/uij.2013.e1.
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The objective of this study was to review our clinical experience in the surgical management of non obstetrical vesicovaginal fistulae (VVF) over the past 13 years, to determine common causes of fistulae in a modern hospital setting and outcomes based on different surgical approaches and timing of repair. A retrospective review of patients with VVF at the Adelaide Meath Hospital, Dublin, was undertaken from January 1997 to June 2010. 35 patients with mean age of 32 years (range 17 to 53 years) with vesicovaginal fistulae underwent surgical repair. A percentage of 68.5 fistulae occurred post hysterectomy, 20% were due to pelvic malignancy and the remainder from other causes. With regards to the timings of surgery, 57% were repaired within 3 months, 11% within 6 months and 32% after 6 months. 57% of patients underwent abdominal repair of fistulae and 26% had vaginal repair. 6 patients were not suitable for any type of repair and hence had urinary diversion. There were 3 failures, all after abdominal repair for complex fistulae. Timing of surgery has no apparent impact on the final outcome of the fistula. The type of approach depends on the preference and experience of the surgeon, with different approaches offering equally good results at our institution. Urinary diversion is still an option for a select group of patients.
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Arrowsmith, S. "Obstetric Fistula in 2015 and Beyond." Nepal Journal of Obstetrics and Gynaecology 10, no. 1 (August 17, 2015): 1–2. http://dx.doi.org/10.3126/njog.v10i1.13185.
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Fistula effort was confined to a very few geographic areas, each of which were completely dominated by the spirit and energy of the founder of a fistula center. The list of leading surgeons contains names familiar to fewer and fewer active fistula care providers: Drs. Ann Ward, John Lawson, and Una Lister in Nigeria were all in the late prime of their lives; in the north of Nigeria, a leprosy surgeon was just getting started in fistula repair at a new center near Katsina: the founder being Dr. Kees Waaldiijk. In eastern Africa, Dr. Abbo Hassan Abbo was dominant in Sudan, the Hamlins in Ethiopia, and an odd band of travelling surgeons, including the late Dr. John Kelly, Dr. Brian Hancock, and Dr. Tom Raassen, were establishing themselves across the region. Also quite active, but completely unheralded were a cadre of non-Western surgeons just beginning long careers in fistula repair: Drs. Mulu Muleta and Ambaye w/ Michael in Ethiopia, Dr. Kalilou Ouattara in Mali, Dr. Serigne Gueye in Senegal, Dr. Khisa Wakasiaka in Kenya, Dr. Ojengbede Akanbi in Ibadan, Nigeria, and Dr. Jonathan Karshima in Jos. Meanwhile, Dr. Kundu Yangzom was quietly establishing a tradition of quality fistula care in Nepal.
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Koothan, Vijaya. "Vesico-cervical fistula following normal vaginal delivery: case report and management overview." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 8 (July 26, 2021): 3232. http://dx.doi.org/10.18203/2320-1770.ijrcog20212988.
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Vesico-uterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder especially in traumatic caesarean sections. We presented a case of vesico-cervical fistula who presented after 18 years of occurrence of fistula and successful repair. Clinical diagnosis may be delayed due to varied presentations and evaluation may require more than one modality of investigation. The choice of treatment surgical or conservative management depends on the location size and number of the fistula. Surgical outcomes of open laparotomy, laparoscopic and robotic surgery have been successful. Obstetric outcomes of post repair patients have had successful pregnancies.
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Shamima, Mosammat Nargis, Rubayet Zereen, Nargis Zahan, Most Rowshan Ara Khatun, Nurjahan Akter, and Mohd Alamgir Hossain. "Management and Outcome of Postoperative Complications among the Patients Undergoing Common Obstetric and Gynaecological Surgery outside the RMCH." TAJ: Journal of Teachers Association 30, no. 2 (December 3, 2018): 7–12. http://dx.doi.org/10.3329/taj.v30i2.39131.
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Objective: To review the management and outcome of postoperative complications after common obstetric and gynecologic surgeries performed in outside nonacademic private hospitals (clinics) and peripheral public hospitals (districts hospitals) and later admitted in Department of Obstetrics and Gynecology of Rajshahi Medical College Hospital (RMCH). RMCH is a tertiary referral hospital where all complicated patients were referred for better management from surrounding hospital.Methodology: This Quasi-experimental study was carried out in the Department of Obstetrics and Gynecology at Rajshahi Medical College Hospital, Rajshahi, Bangladesh between July 1, 2015 and June 30, 2017. All patients admitted with post operative complications following common obstetric and gynecologic surgeries during this period were included. Patients admitted with post operative complications, where primary surgery was done in this hospital were excluded. The common obstetric and gynaecological surgeries were caesarean sections (LUCS), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) performed outside Rajshahi Medical College Hospital.Result: During this period a total of 39,929 patients were admitted through emergency way in obstetrics and gynecology department of Rajshahi Medical College Hospital. Among them 675 patients were admitted with the complaints of post operative complications following common obstetric and gynecologic surgeries with rate being 1.7%. In 560(83%) cases surgery was done in clinics and 115(17%) cases surgery was done in district hospitals. Among the patients 580(85.9%) cases primary operation was done by non-gynaecologic surgeon and 95(14.1%) cases by gynaecologic surgeon. Caesarean section was the primary obstetric surgery in 405(60%) cases .Gynecologic surgeries included TAH in 185(27.4%) cases and VH in 85(12.6%) cases. We found 25(3.7%) patients died from these complications. Repeat surgery was done in 90(13.33%) cases. Genitourinary fistula repair was done in 41 cases (45.55%). Rests were improved by conservative management.Conclusion: Any surgical procedure carries risk of complications. Careful selection of patients with suitable indications for operations, expertise of the surgeon, good surgical technique, proper knowledge of pelvic anatomy and careful postoperative follow up can minimize recognized complications.TAJ 2017; 30(2): 7-12
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Kabir, Ahsan, Arifa Akhter Jahan, MW Islam, MA Awal, A. Rasul, and Abbas Uddin Masum. "Experience of VVF Repair in a Private Peripheral Medical College Hospital." Bangladesh Journal of Urology 14, no. 2 (February 24, 2020): 44–47. http://dx.doi.org/10.3329/bju.v14i2.45580.
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Vesicovaginal fistula (VVF) is one of the oldest diseases of women of child bearing age. It is more common in developing countries and has been a great social and a surgical challenge to Urologists as well as Gynecologists. Though, there have been lot of developments in the understanding the diagnosis, treatment and use of modern technologies for these fistulae but controversies still exists regarding timing and ideal approach for repair. Every woman with obstetric fistula suffers a very miserable life, either socially outcast separated or divorced, unless any help comes forward. 62 cases of fistula were operated at Kumudini Medical College Hospital, Tangail, from April 08 to May 09. Out of these, 50 (80.65%) patients have been cured. This review was taken to look into the results of operation in a peripheral private Medical College with insufficient facilities. Though, prevalence of obstetric fistula was more in our series but number of fistula cases is rising following gynecological operations. VVF is a preventable disease, so more emphasis should be given on the prevention. Surgical operation is the only treatment for VVFs and it doesn’t require too many costly instruments but experience of the surgeon is very important. The scale of problem in our country is enormous. Safe motherhood is birth right of every woman, Government & society should provide that at any cost.
Bangladesh Journal of Urology, Vol. 14, No. 2, July 2011 p.44-47
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Ezekiel, Aaron, C. Okafor Kingsley, J. M. Ijairi, Ayobami A. Mufutau, Steve T. Olaniyan, and Idoko Lucy. "Social Features and Morbidity Patterns of Women with Obstetric Fistulae at an Obstetric Fistula Centre in a University Teaching Hospital in Jos, Nigeria." European Journal of Medical and Health Sciences 3, no. 4 (July 11, 2021): 44–52. http://dx.doi.org/10.24018/ejmed.2021.3.4.844.
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Obstetric fistulae are largely preventable surgical conditions. Literature has shown that it is common among the low income, less privileged and marginalized members of the community. It affects mainly the poor, young, illiterate girls, and women in the remote rural areas of the world, where access to emergency obstetric care, family planning services and skilled birth attendants are unavailable. And when available are poorly utilized due to cost, distance, and other challenges. This study seeks to identify the social features and morbidity characteristics of obstetric fistulae in women at the fistula center in Bingham University Teaching Hospital, Jos, Plateau State, Nigeria. This was a descriptive study done in 2019 among all the patients who attended the obstetric fistula Centre at Bingham University Teaching Hospital. An Interviewer-administered structured questionnaire was used, and it looked at social and health aspects of obstetric fistulae in all 49 patients at the center. Data was analyzed using a computer software; Statistical Package for the Social Science (SPSS) version 20.0. Most of patients had some form of financial support especially from family members, husbands, parents, and friends. Most of the women had their relationships affected. Majority were separated, and relationships strained and had lost financial support from their spouses. Sexual Intercourse was adversely affected. On surgical outcome, 16% became completely dry and leaking had ceased, a third (36.7%) was still leaking urine after the surgery. Almost all the women have had no childbirth after the repair. Women had mental health issues like depression, anxiety, tension headache, fatigue, and suicidal ideation. Participants also had gynaecological morbidities like vulval dermatitis, irregular menstrual flow, abnormal vaginal discharge, and dysuria. These women also had lower abdominal pains, loss of weight, backache, and foot drop. Majority of the children did not survive after the pregnancy that led to the obstetric fistula. Women should seek financial support from family members to avoid delays in seeking help during pregnancy. Communities are encouraged to continue to give moral, emotional, financial, and social support to fistula patients. Healthcare workers should take advantage of the fact that most women attended ANC to educate and enlighten pregnant women on causes, risk factors, social and health consequences of obstetric fistulae. Government should initiate poverty alleviation activities and help reduce out of pocket expenses for healthcare via health insurance.
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Pradhan, Hema Kumari, Ganesh Dangal, Aruna Karki, Ranjan Shrestha, Kabin Bhattachan, Rekha Poudel, Nishma Bajracharya, Kenusha Devi Tiwari, Seth Cochran, and Bryony Michaelson. "Using The Global Obstetric Fistula Electronic Registry to Digitalize Patient Records in Kathmandu Model Hospital." Nepal Journal of Obstetrics and Gynaecology 13, no. 2 (November 18, 2018): 44–46. http://dx.doi.org/10.3126/njog.v13i2.21709.
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Aim: The aim of the study was to collect and digitalize data of patients who underwent fistula repair at Kathmandu Model Hospital. Once data were collected, a Tableau dashboard was built to visualize the collected data and to share key insights.
Methods: Operation Fistula built a digital version of Kathmandu Model Hospital’s Surgery Log, using a mobile data collection tool (CommCare). Researchers were trained on the data collection tool and provided with an electronic tablet device which hosted the application. Kathmandu Model Hospital then proceeded to input patient records, meanwhile providing Operation Fistula with key feedback to continue improving this process.
Results: The results of this process have been threefold: facilitation of data collection, creation of an accurate database and provision of clear insights with access to data visualization dashboards.
Conclusions: This study has shown the benefits of digitizing historical patient records using Operation Fistula’s Global Obstetric Fistula Electronic Registry (GOFER) platform. By creating an online database, this has the potential to be used for future academic research.
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Watt, Melissa, Alexis Dennis, Sarah Wilson, Mary Mosha, Gileard Masenga, Kathleen Sikkema, and Korrine Terroso. "Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania." International Journal of Women's Health Volume 8 (September 2016): 429–39. http://dx.doi.org/10.2147/ijwh.s110202.
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Sheikh, Md Shahadot Hossain, Md Omar Faruk, Farhana Begum, Mst Maksuda Parvin, Md Rayhanur Rahma, Tariq Akhtar Khan, and Lsmat Jahan Lima. "Endorectal Local Advancement Flap in Treating Rectovaginal Fistula-Our Experience in Bangabandhu Sheikh Mujib Medical University." Journal of Surgical Sciences 18, no. 2 (November 4, 2019): 62–66. http://dx.doi.org/10.3329/jss.v18i2.43758.
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Background: Rectovaginal fistula is abnormal epithelial-lined connections between the rectum and vagina. Rectovaginal fistula represents an often devastating condition in patients and a challenge for surgeons. Successful management of this condition must take into account a variety of variables including the etiology, size, and location of the fistula. Repair options include advancement flaps, plugs, fistula ligation, and tissue interposition.
Method: We treated five cases of low rectovagianl fistula by endorectal local advancement flap in Colorectal Surgery Unit of Bangabandhu Sheikh Mujib Medical University between January 2011 to January 2014. Aim of this study was to evaluate the outcome of Endorectal local advancement flap in terms of cure, recurrence or failure in the management of rectovaginal fistula.
Result: Out of five, four patients had rectovaginal fistula due to obstetric cause, one was post-surgical. One patient developed partial flap necrosis. The patient was managed by conservative means. Post-operative hospital stay was 5 days (range 4 -7 days). All patients achieved complete healing after the procedure.
Conclusion: Rectovaginal fistula repair by endorectal local advancement flap should be part of the armamentarium of colorectal surgeons for treating persistent rectovaginal fistula.
Journal of Surgical Sciences (2014) Vol. 18 (2) : 62-66
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Morhason-Bello, Imran O., Sikiru A. Adebayo, Rukiyat A. Abdusalam, Oluwasomidoyin O. Bello, Kehinde H. Odubamowo, Olatunji O. Lawal, E. Oluwabunmi Olapade-Olaopa, and Oladosu A. Ojengbede. "Bilateral Double Ureters with Bladder Neck Diverticulum in a Nigerian Woman Masquerading as an Obstetric Fistula." Case Reports in Urology 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/801063.
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A 43-year-old woman presented with 20-year history of leakage of urine per vaginam. She had one failed repair attempt. Pelvic examination with dye test showed leakage of clear urine suggestive of ureterovaginal fistula. The preoperative intravenous urogram revealed duplex ureter and cystoscopy showed normally cited ureteric orifices with two other ectopic ureteric openings and bladder diverticula. The definitive surgery performed was ureteric reimplantation (ureteroneocystostomy) of the two distal ureteric to 2 cm superiolateral to the two normal orifices and diverticuloplasty. There was resolution of urinary incontinence after surgery. Three months after surgery, she had urodynamic testing done (cystometry), which showed 220 mLs with no signs of instability or leakage during filling phase but leaked on coughing at maximal bladder capacity. This is to showcase some diagnostic dilemma that could arise with obstetric fistula, which is generally diagnosed by clinical assessment.
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Chang, Olivia H., Prakash Ganesh, Jeffrey P. Wilkinson, and Rachel J. Pope. "Extended bladder catheterization for women with positive dye tests after obstetric vesicovaginal fistula repair surgery." International Journal of Gynecology & Obstetrics 149, no. 1 (January 8, 2020): 61–65. http://dx.doi.org/10.1002/ijgo.13088.
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Baloch, Bilqis Aslam Baloc, Abdul Salam, Zaib Un Nisa, and Haq Nawaz. "VESICO-VAGINAL FISTULAE;." Professional Medical Journal 21, no. 05 (December 14, 2018): 851–55. http://dx.doi.org/10.29309/tpmj/2014.21.05.2534.
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Objectives: To review the causes, diagnosis and treatment of vesico-vaginalfistulae in the department of Gynaecology& Obstetrics, and Urology Department Civil HospitalQuetta. Background: Vesico-vaginal fistula is not life threatening medical disease, but the womanface problems like demoralization, isolation, social boycott and even divorce. The etiology ofthe condition has been changed over the years and in developed countries obstetrical fistulaare rare and they are usually result of gynecological surgeries or radiotherapy. In countrieslike Pakistan the situation is different, here literacy rate is low, parity rate is high and medicalfacilities are deficient. People manage delivery at home and usually multi parity. Urogenital fistulasurgery doesn’t require special or advance technology but needs experienced urogynecologistwith trained team and post operative care which can restore health, hope and sense of dignityto women. Methods: A retrospective study of 60 patients with different types of vesico-vaginalfistula werereviewed between January 2005 to December 2008. Patients were analyzed withregard to age, parity, cause, diagnosis, mode of treatment and outcome. Patients were alsoevaluated initially according to prognosis. Results: During the study of four year period 60patients of vesico-vaginal fistulae were reviewed. Majority of the patients were belonging tomiddle age group. In 48 patients repair was done through transvaginal route and 12 wereoperated through transabdominal route. One Ca patient expired and in 4 patients recurrenceoccurred. Conclusions: Iatrogenic vesico-vaginal fistulae are more common. Difficult andcomplicated fistulae need experienced surgeon. Establishment of separate fistula surgery unitis suggested to get desired results.
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Roman, Horace, Valérie Bridoux, Benjamin Merlot, Benoit Resch, Rachid Chati, Julien Coget, Damien Forestier, and Jean-Jacques Tuech. "Risk of bowel fistula following surgical management of deep endometriosis of the rectosigmoid: a series of 1102 cases." Human Reproduction 35, no. 7 (July 1, 2020): 1601–11. http://dx.doi.org/10.1093/humrep/deaa131.
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Abstract STUDY QUESTION What are the risk factors and prevalence of bowel fistula following surgical management of deep endometriosis infiltrating the rectosigmoid and how can it be managed? SUMMARY ANSWER In patients managed for deep endometriosis of the rectosigmoid, risk of fistula is increased by bowel opening during both segmental colorectal resection and disc excision and rectovaginal fistula repair is more challenging than for bowel leakage. WHAT IS KNOWN ALREADY Bowel fistula is known to be a severe complication of colorectal endometriosis surgery; however, there is little available data on its prevalence in large series or on specific management. STUDY DESIGN, SIZE, DURATION A retrospective study employing data prospectively recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis (CIRENDO) from June 2009 to May 2019, in three tertiary referral centres. PARTICIPANTS/MATERIALS, SETTING, METHODS One thousand one hundred and two patients presenting with deep endometriosis infiltrating the rectosigmoid, who were managed by shaving, disc excision or colorectal resection. The prevalence of bowel fistula was assessed, and factors related to the complication and its surgical management. MAIN RESULTS AND THE ROLE OF CHANCE Of 1102 patients enrolled in the study, 52.5% had a past history of gynaecological surgery and 52.7% had unsuccessfully attempted to conceive for over 12 months. Digestive tract subocclusion/occlusion was recorded in 12.7%, hydronephrosis in 4.5% and baseline severe bladder dysfunction in 1.5%. An exclusive laparoscopic approach was carried out in 96.8% of patients. Rectal shaving was performed in 31.9%, disc excision in 23.1%, colorectal resection in 35.8% and combined disc excision and sigmoid colon resection in 2.9%. For various reasons, the nodule was not completely removed in 6.4%, while in 7.2% of cases complementary procedures on the ileum, caecum and right colon were required. Parametrium excision was performed in 7.8%, dissection and excision of sacral roots in 4%, and surgery for ureteral endometriosis in 11.9%. Diverting stoma was performed in 21.8%. Thirty-seven patients presented with bowel fistulae (3.4%) of whom 23 (62.2%) were found to have rectovaginal fistulae and 14 (37.8%) leakage. Logistic regression model showed rectal lumen opening to increase risk of fistula when compared with shaving, regardless of nodule size: adjusted odds ratio (95% CI) for disc excision, colorectal resection and association of disc excision + segmental resection was 6.8 (1.9–23.8), 4.8 (1.4–16.9) and 11 (2.1–58.6), respectively. Repair of 23 rectovaginal fistulae required 1, 2, 3 or 4 additional surgical procedures in 12 (52.2%), 8 (34.8%), 2 (8.7%) and 1 patient (4.3%), respectively. Repair of leakage in 14 patients required 1 procedure (stoma) in 12 cases (85.7%) and a second procedure (colorectal resection) in 2 cases (14.3%). All patients, excepted five women managed by delayed coloanal anastomosis, underwent a supplementary surgical procedure for stoma repair. The period of time required for diverting stoma following repair of rectovaginal fistulae was significantly longer than for repair of leakages (median values 10 and 5 months, respectively, P = 0.008) LIMITATIONS, REASONS FOR CAUTION The main limits relate to the heterogeneity of techniques used in removal of rectosigmoid nodules and repairing fistulae, the lack of accurate information about the level of nodules, the small number of centres and that a majority of patients were managed by one surgeon. WIDER IMPLICATIONS OF THE FINDINGS Deep endometriosis infiltrating the rectosigmoid can be managed laparoscopically with a relatively low risk of bowel fistula. When the type of bowel procedure can be chosen, performance of shaving instead of disc excision or colorectal resection is suggested considering the lower risk of bowel fistula. Rectovaginal fistula repair is more challenging than for bowel leakage and may require up to four additional surgical procedures. STUDY FUNDING/COMPETING INTEREST(S) CIRENDO is financed by the G4 Group (The University Hospitals of Rouen, Lille, Amiens and Caen) and the ROUENDOMETRIOSE Association. No financial support was received for this study. H.R. reports personal fees from ETHICON, Plasma Surgical, Olympus and Nordic Pharma outside the submitted work. The other authors declare no conflict of interests related to this topic.
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Byrnes, Jenifer N., Jennifer J. Schmitt, Benjamin M. Faustich, Kristin C. Mara, Amy L. Weaver, Heidi K. Chua, and John A. Occhino. "Outcomes of Rectovaginal Fistula Repair." Female Pelvic Medicine & Reconstructive Surgery 23, no. 2 (2017): 124–30. http://dx.doi.org/10.1097/spv.0000000000000373.
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Unger, Cecile A., Sarah L. Cohen, Jon I. Einarsson, and Abraham N. Morse. "Laparoscopic Repair of Vesicouterine Fistula." Female Pelvic Medicine & Reconstructive Surgery 18, no. 3 (2012): 190–92. http://dx.doi.org/10.1097/spv.0b013e318254f088.
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Zia, Qamar, Asma Rizwan, Adil Khurshid, Mudassar Sajjad, Muhammad Nawaz, Muhammad Akmal, and Faran Kiani. "O’CONOR (TRANSABDOMINAL) REPAIR: IS IT ALWAYS NECESSARY TO INTERPOSE A FLAP IN SIMPLE VESICO-VAGINAL FISTULA? A COMPARATIVE STUDY." PAFMJ 71, no. 1 (February 25, 2021): 347–50. http://dx.doi.org/10.51253/pafmj.v71i1.3599.
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Objective: To assess morbidity and success of transabdominal (O’Conor) repair of vesicovaginal fistula with orwithout interposition of flap between vagina and urinary bladder.
Study Design: Prospective comparative study.
Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2016 to Jan 2019.
Methodology: Fifty five patients were randomized into group A & B by lottery method. An inclusion criterionwas single fistulous opening of ≤3cm. Complex and recurrent fistulae were excluded. Patients in group A underwent O’Conor repair without interpositional flap while in group B vesicovaginal fistulae were repaired with flap interposition.
Results: Twenty two patients were randomized in group A while 27 in group B. Mean age of patients was 41.65± 11.93 years. Gynecological and obstetrical surgery was the main cause of fistula. Mean duration of surgerywas 162.7 ± 18.49 minutes. Per-operative ureteric catheterization was done in 9 (16.8%) patients. Seventeen(30.6%) patients had paralytic ileus. There was transient fever in 4 (7.6%) of cases and wound infection was seenin 3 (5.8%) of patients. Mean hospital stay was 3.4 ± 2.3 days. Cystogram was done in 35 (64.5%) of patients before the removal of per-urethral catheter. The overall success rate was 92.9%. Ten (18.2%) of patients developed denovo urgency which was managed conservatively. There was no statistical difference in both groups in terms of morbidity and success.
Conclusion: In simple Vesico-vaginal fistulae repair, interposition of flap can be omitted and it does not affect the outcomes in terms of success and morbidity.
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D'Elia, Carolina, Pierpaolo Curti, Maria Angela Cerruto, Carmelo Monaco, and Walter Artibani. "Large Urethro-Vesico-Vaginal Fistula due to a Vaginal Foreign Body in a 22-Year-Old Woman: Case Report and Literature Review." Urologia Internationalis 95, no. 1 (August 13, 2014): 120–24. http://dx.doi.org/10.1159/000365421.
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In the non-industrialized countries of Africa and Asia obstetric fistulas are more frequently caused by prolonged labour, whereas in countries with developed healthcare systems they are generally the result of complications of gynaecological surgery or, rarely, benign pathologies like inflammation or foreign bodies. A 22-year-old woman was brought to the gynaecology clinic because of foul-smelling vaginal discharge. On pelvic examination a ring-like foreign body was impacted between the anterior and posterior vaginal wall. MRI scan confirmed the presence of a cylindrical foreign body in the vagina and the patient revealed that she had ‘involuntarily' inserted a plastic bubble bath cap into the vagina. At surgery removal of the cap was difficult and at the end of the manoeuver evidence of a huge urethro-vesico-vaginal fistula occurred. The patient was discharged with bilateral ureteral stents and suprapubic catheter. After 3 months we performed an end-to-end anastomotic urethroplasty to repair the urethral avulsion and restored the bladder/trigonal and vaginal/cervical defects with 3 layers of sutures; 3 months later the patient had no complaints. Complex genital fistulas represent an extremely debilitating morbidity. In our case, a vaginal approach was successful, but the choice between an abdominal or vaginal approach depends on the surgeon's experience and training.
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Ramesh, B. "Laparoscopic repair of vesico-uterine fistula: A rare surgery." Journal of the American Association of Gynecologic Laparoscopists 10, no. 3 (August 2003): S68. http://dx.doi.org/10.1016/s1074-3804(03)80213-x.
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Bishinga, A., R. Zachariah, S. Hinderaker, K. Tayler-Smith, M. Khogali, J. van Griensven, W. van den Boogaard, M. Tamura, B. Christiaens, and G. Sinabajije. "High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward?" Public Health Action 3, no. 2 (June 21, 2013): 113–17. http://dx.doi.org/10.5588/pha.13.0001.
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Barone, Mark A., Vera Frajzyngier, Joseph Ruminjo, Frank Asiimwe, Thierno Hamidou Barry, Abubakar Bello, Dantani Danladi, et al. "Determinants of Postoperative Outcomes of Female Genital Fistula Repair Surgery." Obstetrics & Gynecology 120, no. 3 (September 2012): 524–31. http://dx.doi.org/10.1097/aog.0b013e31826579e8.
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Welk, Blayne, Christopher Wallis, David D’Souza, Jacob McGee, and Robert K. Nam. "A Population-Based Assessment of Urologic Procedures and Operations After Surgery or Pelvic Radiation for Cervical Cancer." International Journal of Gynecologic Cancer 28, no. 5 (June 2018): 989–95. http://dx.doi.org/10.1097/igc.0000000000001266.
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ObjectiveThe treatment of cervical cancer can result in genitourinary morbidity. We measured selected urologic procedures after the treatment of cervical cancer with either surgery or radiation.MethodsWe used administrative data from the province of Ontario Canada to identify adult women who had nonmetastatic cervical cancer and were treated with surgery or radiation between 1994 and 2014. Study outcomes were surgical or procedure codes representing ureteric repair or fistula repair. Stress incontinence surgery, minimally invasive urologic procedures, open bowel/bladder surgeries, and secondary malignancy were measured to compare between treatment modalities. Multivariable Cox proportional hazards models were used.ResultsOur final cohort consisted of 7311 women (median follow-up, 7.0 years [interquartile range, 2.9–13.3 years]), of which 3354 (44.9%) underwent radiation, and 3957 (54.1%) underwent surgery. After treatment of cervical cancer, ureteral repair was less common after surgery (3.4%) compared with radiation (10.3%) (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.19–0.32). Fistula repair was uncommon (0.9%) and occurred significantly more often in the surgery and radiation group compared with the radiation-alone group (HR, 4.02; 95% CI, 1.80–9.00). Overall, stress incontinence surgery was uncommon (2.2%) but was significantly more likely after surgery versus radiation (HR, 3.73; 95% CI, 2.13–6.53). Minimally invasive urologic procedures were less common after surgery compared with radiation (HR, 0.49; 95% CI, 0.44–0.54). Open bowel/bladder surgeries were similar among treatment modalities, and secondary malignancy was less common after treatment with surgery versus radiation (HR, 0.60; 95% CI, 0.39–0.92;P= 0.02).ConclusionsWomen treated for cervical cancer undergo ureteral stricture interventions at 0.8% per year over the 20 years after their treatment; this risk is higher among women who receive radiation treatment. Fistula repair is rare after cervical cancer.
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Lawal, Olatunji, Oluwasomidoyin Bello, Imran Morhason-Bello, Rukiyat Abdus-salam, and Oladosu Ojengbede. "Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors." Obstetrics and Gynecology International 2019 (February 10, 2019): 1–6. http://dx.doi.org/10.1155/2019/6456141.
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Background. Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods. A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results. Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion. Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.
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Akter, Shimul, Fouzia Mujib, Mohammed Masudur Rahman, Dewan Shahida Banu, Taslima Begum, Tahmida Firdousi, and Dipika Rani Mondal. "Surgical Outcome of Vesico-Vaginal Fistula (VVF) after Repair: Experience of 51 Cases in a Teaching Hospital of Dhaka City." Journal of National Institute of Neurosciences Bangladesh 5, no. 1 (July 12, 2019): 29–32. http://dx.doi.org/10.3329/jninb.v5i1.42165.
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Background: Surgical management of vesico-vaginal fistula is very crucial regarding the outcomes among the women.
Objectives: The purpose of the present study was to see the surgical outcomes of vesico-vaginal fistula.
Methodology: This cross-sectional study was carried out from July 2013 to December 2013 for a period of 6 months in the National Fistula Centre in the Department of Obstetrics & Gynaecology at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. All patients who underwent surgical repair for iatrogenic VVF in National Fistula Centre of the department of Obstetrics and Gynaecology of Dhaka Medical College Hospital were included in this study. Patients who got themselves admitted to Obstetrics & Gynaecology department of DMCH with the complaints of fistula. An interview usually lasted for an hour. The entire selected patients were interviewed for detailed history. Thorough physical examination was done. The surgical outcomes were recorded among the women.
Result: A total number of 51 cases of VVF were recruited for this study. The mean age was 46.02 (±SD 6.104) years. Regarding the causes of iatrogenic vesico-vaginal fistula most of the cases (88.2%) were abdominal hysterectomy. In 4(7.8%) patients lower segment caesarean section caused the situation. Vaginal hysterectomy was responsible for 3.9% (2/51) cases of iatrogenic VVF. In more than 90% cases (46/51) the surgical outcome was successful; while in 5 patients’ fistula recurred 5 to 7 days following surgery. They were treated by re-operation later on.
Conclusion: In conclusion abdominal hysterectomy is the most common cause of iatrogenic vesico-vaginal fistula with a very good surgical outcomes.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 29-32
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Wanjala, Anthony, Henry Mwangi, and Hillary Mabeya. "Pattern of Ureteric Pathology Presenting to a Fistula Centre in Western Kenya." Advances in Urology 2018 (2018): 1–4. http://dx.doi.org/10.1155/2018/5056049.
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Background. Ureteric pathology arises from surgical misadventures, trauma, and congenital anomalies. Early detection and treatment is of the essence. Objectives. To determine the types/etiology and outcome of ureteric pathology presenting to Gynocare Fistula Centre, Eldoret, Kenya. Methods. Descriptive retrospective study that evaluated patients presenting with ureteric pathology at Gynocare between 1st January 2012 and 31st December 2016. We pulled out patient charts and extracted and analyzed relevant data using STATA 13E statistical software. Results. We analyzed 33 charts, and their age ranged from 10 to 58 years. Annual proportion for 2012, 2013, 2014, 2015, and 2016 was 2.5%, 2.8%, 1.2%, 1.4%, and 3.0% respectively among all the fistula patients treated in the hospital. All the patients presented with urinary incontinence, and 7 (21.2%) had flank pain. Iatrogenic injuries contributed 84.8% (28), and 3 (9.1%) were congenital while trauma and infection had 1 each. Of those resulting from surgical misadventures, 17 (60.7%) were from obstetric while 11 (39.2%) were from gynecological surgery. All the injuries were in the distal third of the ureter; 5 were bilateral; and 11 were left sided while 17 were right-sided. Repair and/or reimplantation was successful in 31 (93.93%) of the patients. Conclusion. Highest proportion of ureteric pathologies was accounted for by iatrogenic causes and surgical repair and/or reimplantation has a high success rate.
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Karp, Natalie E., Emily K. Kobernik, Mitchell B. Berger, Chelsea M. Low, and Dee E. Fenner. "Do the Surgical Outcomes of Rectovaginal Fistula Repairs Differ for Obstetric and Nonobstetric Fistulas? A Retrospective Cohort Study." Female Pelvic Medicine & Reconstructive Surgery 25, no. 1 (2019): 36–40. http://dx.doi.org/10.1097/spv.0000000000000484.
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Adelowo, Amos, Richard Ellerkmann, and Peter Rosenblatt. "Rectovaginal Fistula Repair Using a Disposable Biopsy Punch." Female Pelvic Medicine & Reconstructive Surgery 20, no. 1 (2014): 52–55. http://dx.doi.org/10.1097/spv.0b013e3182a33194.
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Kabore, Fasnéwindé Aristide, Stéphanie Dominique Amida Nama, Boureima Ouedraogo, Moussa Kabore, Adama Ouattara, Brahima Kirakoya, and Gilles Karsenty. "Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study." Advances in Urology 2021 (January 20, 2021): 1–7. http://dx.doi.org/10.1155/2021/8838146.
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Objective. To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years’ period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. Results. 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05–3.1]), low level of education (OR = 5.4; CI = [2.3–12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7–6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1–4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1–20.5]). Conclusion. OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.
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Karram, M., and S. Kleeman. "VIDEO 3: Vaginal Repair of Recurrent Vesico-Vaginal Fistula." Journal of Pelvic Medicine and Surgery 11, no. 2 (March 2005): 96. http://dx.doi.org/10.1097/01.spv.0000157257.58333.97.
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Miklos, John R., and Robert D. Moore. "Failed Omental Flap Vesicovaginal Fistula Repair Subsequently Repaired Laparoscopically Without an Omental Flap." Female Pelvic Medicine & Reconstructive Surgery 18, no. 6 (2012): 372–73. http://dx.doi.org/10.1097/spv.0b013e3182751139.
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Tarr, Megan, Sandy Culbertson, and Ernst Lengyel. "Transverse Transperineal Repair of a Pessary-induced Mid-rectovaginal Fistula." Journal of Pelvic Medicine and Surgery 14, no. 3 (May 2008): 199–201. http://dx.doi.org/10.1097/spv.0b013e318176b2e2.
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Hampton, Brittany Star, René M. Ward, and Abdoulaye Idrissa. "Attitudes and Expectations of Women Undergoing Vaginal Fistula Repair in Niger." Journal of Pelvic Medicine and Surgery 15, no. 6 (November 2009): 441–47. http://dx.doi.org/10.1097/spv.0b013e3181bdca61.
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Sharma, Abha, Amita Suneja, Kiran Guleria, Yashika Motwani, and Nilanchali Singh. "Latzko Operation for Repair of Posthysterectomy Fistula: Reappraisal of an Exemplary Method." Journal of Gynecologic Surgery 32, no. 4 (August 2016): 211–14. http://dx.doi.org/10.1089/gyn.2015.0129.
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Memon, Aijaz Hussain, Mumtaz Ali, Salman Manzoor Qureshi, Wasim Sarwar Bhatti, Naveed Ahmed, and Mujeeb ur Rehman. "Comparison of Vesicovaginal Fistula Repair with Omental transposition versus perivesical fat emplacement." Professional Medical Journal 26, no. 12 (December 10, 2019): 2146–50. http://dx.doi.org/10.29309/tpmj/2019.26.12.3497.
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Objectives: To compare the outcome of Vesicovaginal fistula repair by omental transposition and perivesical fat emplacement in terms of recurrence and maximum bladder capacity. Study Design: Randomized control trial. Setting: Urology department of Peoples University Hospital Nawabshah, Sindh, Pakistan. Period: From January 2018 to December 2018. Material & Method: Overall 40 patients with VVF were added in the research, split into two identical groups, each consisting of 20. In group 1, omental transposition and in group 2, perivesical fat emplacement was done. Adult female patients with Vesicovaginal fistula, resulting from obstetrical and as a complication of surgery was included. This was confirmed by physical examination, IVU, pelvic computerized tomography scan with contrast, retrograde uretherocystogram, ultrasound KUB and cystoscopy. Exclusion criteria were Patients with systemic illness like diabetes mellitus, chronic renal failure and chronic liver disease etc, immunosuppressant therapy like: steroids intake, patient’s undergone irradiation of the pelvis due to any malignant disease. Follow up after 6, 12 and 24 weeks, all the patients were assessed for recurrence. The complications like wound infections, urgency, urge incontinence and paralytic ileus were also noted. The data was collected in a specially designed proforma. Results: In this study 40 patients fulfilling the inclusion criteria were included, 20 patients in each group. The success rate was 95 %( 19 /20) in group 1, only one case had recurrence. While in group 2 all the cases were successful. Chi square analysis was employed for comparison of adequacy of both the techniques, the P value was found to be 0.311 which suggests that the difference between the efficacies was not statistically significant. Conclusion: It is concluded that both the techniques of Vesicovaginal fistula repair, either with omental transposition or perivesical fat emplacement are equally good in terms of recurrence and maximum bladder capacity.