Vesico-vaginal fistula surgery in Uganda

Abstract

Background: Childbirth injuries are common in Uganda. This paper describes our experience with Vesico-vaginal Fistula repair and aftercare.

Methods: Between 1999 and 2003, 341 consecutive patients underwent VVF repair complicating childbirth trauma. Another 29 VVF patients were seen but not operated because of time constraints. Five new patients who were considered inoperable from the start.

Results: The mean age was 27 years and the mean duration of the fistula was 6 years. New cases comprised 82% of the cases. Over half (55%) of the patients were primiparous. Nearly two-thirds (64%) of cases had delivered by Caesarean section. Surgery was attempted in almost every patient regardless of how complicated the VVF was. Only 20% of VVF repairs were assessed as being easy. Early in the series an abdominal approach was generally used for vesico-cervical fistulae following Caesarean section. With increasing experience however, the transvaginal approach became the procedure of choice. The majority were repaired in a single layer. Rarely fat grafts were used. Postoperative care was simplified to free open drainage of the catheter via plastic tubing into a small bucket under the bed. Most patients were allowed out of bed from day two. A high fluid intake was encouraged at all times starting before the operation. Around 90% were closed at the first attempt but a further 10% may have unacceptable stress incontinence.

Conclusion: We believe there is a reservoir of untreated VVF patients in Uganda and fistula camps can make a significant contribution to teaching and cure of patients