الخلاصة

Abstract ABSTRACT:BACKGROUND:Vesicovaginal fistula (VVF) represents a significant morbidity in female Urology. Although surgical success is achieved in the majority of cases, a 4 to 35% failure rate occurs when a transvesical or transvaginal approach is used.OBJECTIVE:The aim of the present study is to describe our experience and effectiveness of transabdominal repair of vesicovaginal fistula with peritoneal flap interposition.PATIENTS AND METHODS:A total of 18 patients with VVF (16 primary, 2 recurrent) were repaired transabdominally with peritoneal flap interposition at Al-Najaf teaching hospital , Iraq ,during the period from March 2007 to January 2010.Approaching the bladder transperitoneally with bivalving the bladder which separated from vagina to allow tension free closure in separate layers with interposition of peritoneal flap. The outcome was classified into sealed fistula (cured) and recurrent fistula(failed) and was carried out for all patients by thorough clinical assessment 4 weeks after removal of the catheter.RESULTS:The mean age was (39.33±10.19) years (range 25-62) and the parity ranged from 1 to 13 (mean 5.38±3.46) .(10) patients (55.55%) had VVF due to obstetric causes.(7) patients (38.88%) had VVF due to gynecologic causes.(1) patients (5.55%) had VVF due to Iatrogenic causes.The size of the fistula ranged from 1 cm to 12 cm (mean 3.94±2.65). The vesicovaginal fistula was successfully corrected in all patients at the first attempt. No significant bladder dysfunction or decrease in bladder capacity was seen after repair.CONCLUSION:A peritoneal flap for transabdominal repair of vesicovaginal fistula is safe and achieves excellent functional results.Although a high success rate of repair,we should focus attention on strategies of prevention.