SURGICAL OUTCOMES OF GENITOURINARY FISTULAE

Abstract

Background: Genitourinary fistulae are known complications of prolonged labour and pelvic surgery. Successful treatment outcomes hinge on detailed evaluation of the site of fistula, appropriate timing and technique of surgery. The objective of this study was to study the presentation, aetiology, evaluation of different treatment options and treatment related complications. Methods: All patients reporting with urinary incontinence due to genitourinary fistulae were enlisted. Patients were investigated to determine the cause of fistula. Evaluation of the site and size of the fistula was done by clinical examination. IVU, EUA and urethrocystoscopy were used to develop treatment plan; treatment and follow-up to assess and document the progress including treatment result, complications and quality of life. Results: Iatrogenic injury was the leading cause in 18 post-hysterectomy fistula cases, 4 cases were post C-section, and 4 cases were after prolonged labour. There were 22 Vesico Vaginal Fistulae (VVF) and 4 cases of Uretero Vaginal fistulae. Five fistualae were treated conservatively, vaginal repair was performed in one, and extra peritoneal transvesical approach was used in 3 cases. Four patients had ureteric re-implantation (extra-vesical ureteroneocystostomy). Thirteen patients had trans-vesical trans-peritoneal supra-pubic repair with interposition of J-flap of omentum. Complications observed included failure to heal in 2 patients, wound sepsis 6 cases, and 1 patient required re-exploration for a retained gauze. Conclusion: Majority of the genitourinary fistulae in this study were of iatrogenic aetiology. The duration, size and location of the fistulae were the key determinant in the choice of the treatment method.

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Pak J Physiol 2016;12(4):27–9