46 year old, mother of three children visited Aster Hospital’s Urology OPD in February 2017 with complaints of continuous leakage of urine since the last 6 months.
Her social life was devastated and she has very low self-esteem. She had previously undergone a hysterectomy elsewhere. She did not have any other medical illness or risk factors.
Her case was studied and upon examination it was confirmed that she suffered from Vesicovaginal fistula, for which she underwent CECT and CT Cystography. Her kidneys and ureters were both normal. She incidentally had a Duplex collecting system on the right side with double ureter combining in the distal third.
A cystoscopy and bilateral retrograde pyelography was performed. Multiple holes were found on the posterior wall of the bladder above the trigone with one well-formed fistula opening in the vagina. Both the ureters and the Pelvicalyceal systems were normal (duplex noted as above).
She underwent a Laparotomy and transvesical repair of the Vesicovaginal fistula under Spinal and Epidural anesthesia. The bladder was opened, bivalved, the fistula tract was cored out and transfixed. The vaginal and bladder portions of the fistula closed separately in layers with Omentum interposed. The bladder was closed and a suprapubic, per-urethral catheters were kept. Also a perivesical drain was kept. The drain was removed on POD2, the SPC was removed at the end of the second week and the Foley catheter at the end of the third week. She voided freely after that and has had no leak ever since. She is very happy and grateful.
Vesicovaginal fistula (VVF) formation represents a condition with devastating social and personal consequences for the patient and continues to pose a significant challenge to the surgeon. Quick and accurate diagnosis, followed by timely repair is essential to the successful management of these cases. A thorough understanding of the pathophysiology and anatomy of the fistula, potential factors that may compromise healing and experience in the fundamental principles of fistula repair are the vital tools of the fistula surgeon.