This document summarizes the repair of vesicovaginal fistulas (VVF) performed at Chittagong Medical College from 2001-2015. It discusses that VVF most often occurs due to prolonged obstructed labor causing tissue damage. The majority of VVF cases (94%) can be treated with vaginal repair using a Martius flap with a success rate of 94% and minor complications. While stress incontinence remains an issue, repeated attempts at repair can achieve success. The document recommends that dedicated gynecologists can perform VVF repair in Bangladesh using basic techniques and postoperative care to restore dignity to women suffering from this condition.

1. GREETINGS FROM PORT CITY
CHITTAGONG

3. REPAIR OF VESICOVAGINAL
FISTULA
PROF. ROKEYA BEGUM
DR ZAKIA SULTANA

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

7. VICTIMS

8. In an unequal world these women
are the most unequal among
unequals.

9. “Every 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 fistula”

10. This is not a life threatening medical
emergency
but women face
Social problem:
 Demoralisation,
 socialboycott,
 divorce,
 separation,
 isolated,
 worsening poverty

11. Medical problem
Excoriation of vulva
ulceration
Bladder stone
Offensive odour
Malnutrion
Premature death

12. PREVALENCE
 True incidence in Bangladesh not known
because suferrer remains in silence and
isolation.
 70 -90% are abandoned or divorce.
 Completely ignore about illness and
treatment possibility’
“ Curse from GOD”

13. Chittagong Medical college is a tertiary
health care centre
Total admission in Obstetric and
gynaecology department is 23696 in
2015 .

15. FISTULA CORNER AND BEDS ALLOCATED FOR
VESICOVAGINAL FISTULA

17. OBJECTIVE
To present our experience for the repair of VVF with
special referrence to surgical approach from 2001
to 2015

18. CASE SERIES
 Chittagong Medical College
 Obstetric and gynaecology department
 From 2001 to 2015
 Total patient 428

19. CASE SERIES
Baseline data n=428
Age in years 16 to 60 years
Parity in numbers 1-5
Age at marriage 84%
(<20 yrs)
Height of the pt in cm 64%
<145 cm

20. TYPE
 Obstetric fistula 395
 Post hysterectomy 33
abdominal 30
Vaginal 3

21. LOCALISATION OF FISTULA
Mid vaginal 189 48%
Juxta cervical 110 28%
Circumferrential 96 24%
Post hysterectomy middle of vault

22. SIMPLE FISTULA
– Non-fibrotic tissue
– Easy to access

23. COMPLEX FISTULA
Fistula associated with
- Vaginal stenosis
- -urethral avulsion
- Urethral stricture
- Bladder mucosa prolapse
- Previous failed surgery
- -ureter involve in fistula margin or into the vagina
- -rectovaginal fistula

24. SIZE OF FISTULA
<2 cm 231
2-3 cm 154
>3 cm 43

25. PREOPERATIVE PREPARATION AND CARE
No high technology
Occassionally
Cystoscopy
IVU
Regional anaesthesia
preferable

26. ROUTE OF REPAIR
 Vaginal approach 420
 Transabdominal 05
 Combined 03
 Urinary diversion nil

27. TECHNIQUE
 Adequate exposure
 Wide mobilisation of bladder wall from
vaginal wall at least 2cm
 Tention free closure of bladder wall
 Interpositional graft tissue like martius graft
 Haemostasis
 Post operative care
 Bladder drainage 14 days

29. OUTCOME OF VVF REPAIR
 Success rate 94% 402
 Stress incontinence 4% 17
 Failed repair 2% 08
 Success by repeated attempt maximum six
attempt

31. COMPLICATIONS
Minor
Major (septicemia)
No mortality

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
 Enhancing granulation tissue formation
 Increasing neovascularisation
 Obliteration of dead space
 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
 Majority can be treated by vaginal approach
 Cure can be possible by repeated
attempted
 Martius flap preferable for tissue
interposition

36.  Stress incontinence remains an issue for further
improvement
 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. VVF is our national problem.this
has to be address by us

40. WHAT A SMILE FOR A NEW LIFE!

41. THANK YOU