Complex circumferential obstetric fistula-a urologist's worst nightmare

Area of Science:

• Urology
• Gynecology
• Surgical Innovation

Background:

• Circumferential vesicovaginal fistula is a severe obstetric injury with poor continence prognosis.
• Obstetric injuries, particularly from obstructed labor, can lead to complex fistulas and urinary incontinence.

Observation:

• A 31-year-old woman presented with total urinary incontinence post-obstructed labor and hysterectomy.
• She had a large vesicovaginal fistula with near-total urethral loss, unresponsive to prior vaginal repair attempts.

Findings:

• Successful surgical repair was achieved using the anterior bladder flap technique combined with an autologous rectus sheath sling.
• The patient achieved complete urinary continence postoperatively.

Implications:

• This combined surgical approach offers an effective solution for complex circumferential vesicovaginal fistulas and urethral loss.
• Adopting this technique can significantly improve outcomes for women suffering from this debilitating complication of obstructed labor, especially in developing countries.