Abstract
Combined vesico-vaginal and vesico-cutaneous fistulae are exceptionally rare. We present a young woman who had combined vesico-vaginal fistula and vesico-cutaneous fistula following prolonged obstructed labour and caesarean section. The patient presented at three months of illness with total urine incontinence from the vagina and lower abdominal skin. One-stage surgical repair of both fistulae was done. The patient had a successful closure of the fistulae, regained full urinary continence, and remained continent at six months follow-up. We opine that one-stage repair of combined vesico-vaginal and vesico-cutaneous fistulae is feasible and preferred. Providers of pelvic surgery in low resource countries should be supervised and retrained accordingly, in order to prevent iatrogenic vesico-cutaneous fistula.
Highlights
Urinary fistulae result from a breach in the integrity of the renal system
We present a young woman who had combined vesico-vaginal fistula and vesico-cutaneous fistula following prolonged obstructed labour and caesarean section
We opine that one-stage repair of combined vesico-vaginal and vesico-cutaneous fistulae is feasible and preferred
Summary
Urinary fistulae result from a breach in the integrity of the renal system. Urine by-passes its pathway to surrounding structures which are devoid of sphincteric control. A 24 year old G1P1 presented with three-month history of urinary incontinence following caesarean delivery for prolonged obstructed labour She leaked urine from the vagina and the lower anterior abdominal skin. She had no history of pelvic swelling, haematuria or pyouria. When weak methylene blue solution was instilled into the bladder through a urethral catheter, the anterior vaginal wall and lower abdomen were directly observed (Direct dye test), the dye was seen to leak through the bladder defect to the vagina and the Pfannenstiel scar defect. The margin of the VCF was incised, trimmed and the bladder dissected off the anterior abdominal skin Both structures were repaired with tension free absorbable sutures in separate layers. After removal of the catheter, both fistulae had closed and the patient had regained continence and remained continent at six months follow up
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