First Steps in Vesico-Vaginal Fistula Repair

Abstract

I first came across this outstanding book during a recent working visit to the Fistula Hospital in Addis Ababa in Ethiopia. The endorsement of this book by the surgeons at the Fistula Hospital and their purchase of 500 copies to give to doctors coming to the hospital to learn fistula surgery (and to take with them when they travel to other countries to teach the topic) is a far better commendation than I could give in this review. Brian Hancock, a colorectal surgeon in Manchester, has spent a large part of his life working and teaching ways of repairing these devastating injuries in the non-industrialised world. This book is a true reflection of what he has achieved. The photographs and line drawings are clear and fully complement the text. However, it is not just closing the hole; women with fistulae invariably have numerous other problems (social, psychological and physical), all of which need attention. Stress urinary incontinence is an almost invariable sequence in those with severe fistulae associated with scarring. The recognition in this book of the recently described operation by Andrew Browning, using the divided ischiocavernosus muscle or a sling of fibrous tissue from the lateral pelvic wall, is a major advance and needs to be utilised and validated more widely. Though urine bags are expensive in non-industrialised countries, efforts need to be made to have them more widely introduced. One cannot continue to condone an open system of urine drainage and increased requirement for powerful antibiotics. What about female catheters and leg bags? In the next edition, hopefully, we will hear about the use of urethral plugs and whether or not to blow up the balloon of the catheter post-repair. I hope that reading this book will stimulate surgeons young and old to use their surgical skills and spend time in the non-industrialised world treating these young women. It is most unlikely in the near future that these injuries will be prevented.