Basa Akkamamba1, Nimmala Surendher Reddy2
BACKGROUND
Genitourinary fistulae are known complications of pelvic surgery and prolonged labour. Successful treatment outcomes hinge on detailed evaluation of the site of fistula, appropriate timing and technique of surgery.
The aim of the study is to study the presentation, aetiology and evaluation of different treatment options.
MATERIALS AND METHODS
This is longitudinal prospective study consisting of 30 cases of genitourinary fistulae. Analysis of aetiology and incidence of various types of genitourinary fistulae and diagnosis and management over a period of 1 and ½ years from September 2013 to April 2015. This study was carried out at Mahatma Gandhi Memorial (MGM) Hospital, Warangal, attached to Kakatiya Medical College.
RESULTS
Out of 30 cases, 20 (66.66%) have gynaecological cause of fistulae and 10 (33.33%) cases have obstetric cause of fistulae. Out of 20 gynaecological type of fistulae, vesicovaginal fistulae are 12 cases (60%), ureterovaginal fistulae are 6 cases (30%) and vesicovaginal + ureterovaginal fistulae are only 2 cases (10%). Out of 10 obstetric types of fistulae, vesicovaginal fistulae are seen in 7 cases (70%), vesicouterine fistulae are seen in 1 case (10%) and vesicovaginal + urethrovaginal fistulae are 2 cases (20%). In total 30 cases, 24 (80%) cases developed genitourinary fistulae during surgery, in 3 cases because of ruptured uterus and in 3 cases because of obstructed labour. Most common type of fistulae is vesicovaginal fistulae seen in 63.33% (19 cases), next most common type of fistulae is ureterovaginal fistulae seen in 20% (6 cases), combination of vesicovaginal fistulae + ureterovaginal fistulae is seen in 6.6% (2 cases), combination of vesicovaginal fistulae + urethrovaginal fistulae is seen in 6.6% (2 cases) and vesicouterine fistulae is 3.3% (1 case). Vesicovaginal fistulae causes complete incontinence of urine. Diagnosed mainly by cystoscopy, which detects site and size of fistulae near the trigone or not and number of fistula and associated ureterovaginal fistulae. Other investigation done by CT scan. All the cases are treated by transabdominal and transvesical route. For big fistulae, bivalve method repair done. Out of 19 vesicovaginal fistulae for 17 cases, surgery done in our hospital and 2 cases referred to the higher center.
CONCLUSION
Most common cause for genitourinary fistulae in 80% of cases is surgical. This is increased because of increased incidence of caesarean section rate. Obstetric cause for genitourinary fistulae is decreased because of early decision for caesarean section and also due to decreased incidence of obstructed labour and ruptured uterus. 60% cases recognised during surgery and 40% cases not recognised during surgery.
