Transabdominal repair of vesicovaginal fistulae: A 10-year tertiary care hospital experience in Nigeria.

Abstract

Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. Arguments continue as to the best approach for repair. This study aimed to present our experience with transabdominal VVF repair. This was a 10-year retrospective review of transabdominal VVF repair. Important data extracted from the case notes included patients' demography, aetiology, previous repair, operative findings, procedures and treatment outcome. Data were analysed using SPSS version 21. Bivariate analysis of factors affecting treatment outcome was carried out with the level of significance set at P < 0.05. Fifty-three VVF repairs were carried out in 51 patients. Mean age was 29.8 ± 15.4 years. Forty-five (84.9%) had previous repairs. The aetiologies of VVFs were prolonged obstructed labour in 41 (80.4%) and post-operative in 10 (19.6%). Forty-one repairs were through a transperitoneal transvesical approach whereas 12 had an extraperitoneal transvesical approach. The fistulae diameter ranged from 0.3 to 2.8 cm with an average of 1.64 cm. Six had ureteric re-implantation; (bilateral in two patients). Repair was successful in 47 (88.7%) cases, which translated to the overall success rate of 92.1% in the 51 patients treated. Success rate was higher (95.6%) for the subset of patients who had previous transvaginal repairs. Catheter blockage in the post-operative period was a significant factor that had effect on outcome (P < 0.015). Transabdominal repair recorded an excellent result in patients who had previously failed transvaginal repairs and may be considered as the first option in these patients.