What are the Surgical Options in Patients with Large Complex Vesico-Vaginal Fistula with Destruction of the Bladder Neck?

Abstract

The leading cause of vesico- vaginal fistulae in the medically under developed countries is obstetric trauma. Majority of these fistulae can be repaired using the vaginal approach and the success rate is close to 90%. The cases of vesico –vaginal fistulae referred to the urology unit of Lagos University Teaching Hospital are those that have defied several attempts at vaginal repair.
Majority of these cases can be repaired by an abdominal or progressive abdomino-perineal approach with or without omental pedicle graft, and /or ureteric reimplantation. When such large complex fistulae are associated with destruction of the bladder neck and upper 2cm of the urethra and fibrosis of the genital tract, the surgical options are not many. The young – Dees- lead better repair may be useful but the extensive fibrosis made this impossible.
A report of three such cases treated with ureterosigmoidostomy and a discussion of the treatment option is presented.


NQJHM Vol. 14 (2) 2004: pp. 136-139