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Simultaneous bladder and vaginal reconstruction using ileum in complicated vesicovaginal fistula
Sujata K Patwardhan1, Ajit Sawant, Mohammad Ismail
1Department of Urology, LTMMC and LTMGH, Sion, Mumbai, India.
Objectives:
To discuss the outcome of surgical repair in complicated vesicovaginal fistula with simultaneous bladder and vaginal reconstruction using ileum.
Materials And Methods:
Four female patients in the age group of 12-30 years are included. All the patients had complicated vesicovaginal fistula with vaginal stenosis secondary to obstetric hysterectomy (except one secondary to the genitourinary tuberculosis). Repair of vesicovaginal fistula with simultaneous bladder augmentation, ureteric reimplantation, and reconstruction of vagina using ileum was performed in all the cases.
Results:
All the patients had successful repair of fistula. Vaginal reconstruction using ileum, resulted in capacious vagina. Adult patients resumed to normal sexual life. Mucus discharge was the only complaint in postoperative period.
Conclusions:
Malnutrition, anemia, obstructed labor, Intra uterine fetal death (IUFD), postpartum hemorrhage following forceps delivery in a rural setting followed by an emergency obstetric hysterectomy after a delay of 6-8 h (due to transfer to a tertiary center) were the few contributing factors leading to the formation of vesicovaginal fistula (VVF). Preoperative assessment of bladder capacity and vaginal capacity in such cases is mandatory. The small bowel is a readily available vascular tissue for restoring bladder and vaginal capacity.
