Role of day care vesicovaginal fistula fulguration in small vesicovaginal fistula

Abstract

Objectives: Vesicovaginal fistula (VVF) is a common condition that physically and mentally debilitates the patient. In the developing countries such as India, it results mainly due to neglected obstetric care. Options for surgical repair of VVF consist of transvaginal, transvesical, laparoscopic repair. Endoscopic management of VVF on day care basis by fulgurating the fistulous tract is a minimally invasive method for small fistula involving the lower genitourinary tract. We evaluated the efficacy of fulguration for the conservative treatment of urinary fistula of different etiologies by using endoscopic approach.

Materials and methods: From September 2008 to July 2009, five patients with VVF of <0.7 cm underwent VVF fulguration under cystoscopic guidance on day care basis. Perurethral catheter was kept for 3 weeks postoperatively and was removed when cystogram showed healing of the fistula. All the patients were on anticholinergic medications postoperatively.

Results: Of the five patients who underwent endoscopic fulguration, four patients had positive outcome and one patient showed persistent VVF on follow-up cystogram. This patient underwent repair of the fistula by vaginal route.

Conclusions: Endoscopic transvesical vesicovaginal fistula fulguration appears to be a safe and effective procedure for small VVF on day care basis, with decreasing morbidity, improving cosmesis, and decreased hospital stay.