Abstract
Objective: Vesico-vaginal fistula (VVF) may co-exist with bladder calculi. Traditionally, management entails removal of the calculus and deferment of fistula repair. The study aims to present our findings in the management of women with this combination. Methodology: This is a retrospective review of twenty-three women with vesico-vaginal fistula and bladder calculi managed from December 2008 to June 2014 at the National Obstetric Fistula Centre, Abakaliki, Nigeria. The case history, physical findings, investigation results, operation notes and follow-up notes of twenty women were available and form the basis of this review. Results: The prevalence of bladder calculi among vesico-vaginal fistula patients was 1.45%. Most of the bladder calculi were removed via the transvaginal route. In majority of cases (55%), removal of the calculi and repair of the fistula were performed at the same sitting. Ninety-five percent of the patients had successful repair. Conclusion: The finding suggests that the co-existence of bladder calculi and vesico-vaginal fistula is uncommon. Clinical diagnosis is usually sufficient. Fistula repair could safely be undertaken at the same sitting with removal of the calculus in well-selected cases suggesting a paradigm shift in the management of this combination.
Highlights
Vesico-vagina fistula (VVF) is an abnormal communication between the bladder and the vagina resulting in continuous involuntary leakage of urine through the vagina [1]
This is a retrospective review of twenty-three women with vesico-vaginal fistula and bladder calculi managed from December 2008 to June 2014 at the National Obstetric Fistula Centre, Abakaliki, Nigeria
Ninety-five percent of the patients had successful repair. These findings suggest that the co-existence of bladder calculi and vesico-vaginal fistula is uncommon
Summary
Vesico-vagina fistula (VVF) is an abnormal communication between the bladder and the vagina resulting in continuous involuntary leakage of urine through the vagina [1]. It is a serious reproductive health challenge with enormous medico-social and psychological consequences [2,3]. Up to 97% of cases occur as a complication of prolonged obstructed labour among women who lack access to quality maternity care unlike in the developed world where gynaecologic surgery is the commonest cause [4]. Nigeria is reported to contribute 40% of the global burden of the disease with approximately 12,000 new cases per year [2]. The underlying factors include poverty, illiteracy, cultural practices, early marriage and lack of access to quality healthcare [2,3,6]
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