4. OCCURANCE OF VESICO VAGINAL FISTULA
1.Tissue destruction secondary to the prolonged
pressure of the head during obstructed labour
(ischaemic necrosis)
2. Tissue damage during surgery like Caesarian
section or Caesarian hysterectomy or hysterectomy
8. In an unequal world these women
are the most unequal among
unequals.
9. โEvery minute, a woman dies in
pregnancy or childbirth, and for
every woman who dies, 20-30
others will survive but with
morbidity, one of which is
obstetric fistulaโ
10. This is not a life threatening medical
emergency
but women face
๏ฑSocial problem:
๏ Demoralisation,
๏ socialboycott,
๏ divorce,
๏ separation,
๏ isolated,
๏ worsening poverty
12. PREVALENCE
๏ข True incidence in Bangladesh not known
because suferrer remains in silence and
isolation.
๏ข 70 -90% are abandoned or divorce.
๏ข Completely ignore about illness and
treatment possibilityโ
โ Curse from GODโ
13. Chittagong Medical college is a tertiary
health care centre
Total admission in Obstetric and
gynaecology department is 23696 in
2015 .
27. TECHNIQUE
๏ข Adequate exposure
๏ข Wide mobilisation of bladder wall from
vaginal wall at least 2cm
๏ข Tention free closure of bladder wall
๏ข Interpositional graft tissue like martius graft
๏ข Haemostasis
๏ข Post operative care
๏ข Bladder drainage 14 days
28.
29. OUTCOME OF VVF REPAIR
๏ข Success rate 94% 402
๏ข Stress incontinence 4% 17
๏ข Failed repair 2% 08
๏ข Success by repeated attempt maximum six
attempt
32. CONTROVERSIES IN REPAIR
OF FISTULA
1.When to perform the repair -late versus
early
(Prevention of women for becoming an
outcast)
2.Vaginal versus abdominal
Vaginal route less invasive less blood
loss,avoid laparotomy
33. 3.Use of graft
๏ข Enhancing granulation tissue formation
๏ข Increasing neovascularisation
๏ข Obliteration of dead space
๏ข Prevent recurrence
34. 4.Latex versus silicon catheter
5.Triluminal versus biluminal
6.Early versus late ambulisation
7.Bladder drainage 2 weeks or 3 weeks
35. SUMMARY
๏ข Majority can be treated by vaginal approach
๏ข Cure can be possible by repeated
attempted
๏ข Martius flap preferable for tissue
interposition
36. ๏ข Stress incontinence remains an issue for further
improvement
๏ข Success can be improved by apprenticeship with
one master surgeons
37. RECOMMENDATION
VVF surgery does not require special or
advance technology but needs dedicated
gynaecologist with team and post operative
care which can restore health,hope,and
sense of dignity to women
38. This service can be practised in
any hospital in Bangladesh by
simple modification
39. ๏ขVVF is our national problem.this
has to be address by us