[Post-hysterectomy vesicovaginal fistula]

Abstract

Objective: Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF).

Patients and methods: We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure.

Results: Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure.

Conclusion: In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

Keywords: Bon pronostic; Good prognosis; Hysterectomy; Hystérectomie; Iatrogenic lesions; Lésions iatrogènes.