Vesico-vaginal fistula repair: experience with first twenty-three patients seen at a tertiary hospital in north-central Nigeria

Abstract

Background: Vesico-vaginal fistula (VVF) has been a recurrent challenge to Obstetricians and Gynaecologists in many hospitals in Nigeria. The objective of this study was to determine the causes of VVF, site and size and the success of surgery in VVF patients.
Methods: This was a prospective descriptive study of the first 23 cases of VVF repair at the Federal Medical Centre, Makurdi, from January, 2012 to December, 2014. The clinical records of all patients who had VVF repair were reviewed and analysed.
Results: The main cause of VVF in this study was prolonged obstructed labour accounting for 52.1% followed by iatrogenic causes such as gynaecological procedures (30.4%). Anterior vaginal wall fistula was the commonest defect accounting for 91.3%. Most of the fistulas were less than 5cm and surgery was successful in 80.9% of the cases. Most of the cases (76.2%) were done under regional anaesthesia. Majority (94.1%) of the successful repairs were done under spinal anaesthesia. Most of the patients were discharged after three weeks.
Conclusion: Prolonged obstructed labour was still the leading cause of VVF, though the percentage is lower compared to most reviews across the country. Majority of the cases had successful surgery because of the sizes and the uncomplicated nature of the fistulae. Iatrogenic causes account for about a third of the cases of VVF indicating the need for extra vigilance on the part of the practitioners. Spinal anaesthesia can be used beneficially for VVF repair.

Keywords: Vesico-vaginal fistula, repair, iatrogenic, outcomes.