TRANSVAGINAL REPAIR OF VESICOVAGINAL FISTULA: EXPERIENCE AT A TERTIARY CARE CENTRE.

Abstract

Aim: to highlight the transvaginal route as an effective approach for repair of simple vesico-vaginal and urethro-vaginal stulae without compromising patient outcomes. Materials and Methods: A retrospective analysis was carried out on 45 patients with simple trigonal, supra trigonal and urethrovaginal stula who underwent transvaginal repair in the last 3 years. Simple stulas were dened as stula less than 3 cm in size or recurrent stulae less than 1.5–2 cm in size and located either supra-trigonally (above the bar of mercier) or sub-trigonally (below the bar of mercier) as determined by cystoscopy. Results: Obstetric cause, due to obstructed labour, was the most common cause of stula formation (68.96%), while remaining (29.31%) were attributed to hysterectomy. Primary stulae were found in 68.9% of patients and recurrent stulae in 31.1% patients. The mean age of patients was 34.30 years. Average stula size was 1.5 cm. The success rate of primary operation was 84.12%. On using a multivariate regression model, the underlying aetiology (OR 2.2), stula location (OR 2.5) and history of previous repair (OR 2.4) were found to be signicant factors affecting outcome. Conclusion: The transvaginal approach is less invasive and achieved comparable success rates as compared to other methods of vesico-vaginal stula repair. We postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible vesico vaginal stulae, both of obstetrical and gynaecological origin.