Post-partum vesicovaginal fistula: Abdominal muscle strip treatment

Background. The Vesico-Vaginal Fistula (VVF) very often occur in tropical countries, but their treatment is usually not correct. Methods. A surgical treatment was carried put on 68 patients affected by VVF from March 1986 to December 19997 in the Nazareth Hospital (Nairobi). Their mean age was 22 years old; 27 patients (39.7%) underwent surgery for the first time, while for 41 patients (60.2%) the treatment was repeated. Fourteen patients (20.5%) had also Vesico-Rectum-Vaginal Fistula (VRV). The VVF was cured with a transvaginal treatment using a Martius strip for 32 cases. For 16 cases both vaginal and abdominal treatment was performed in the same time using an abdominal muscle strip, which was inserted in the space between the vagina and bladder. In VRV and VVF combined cases, the VVF was treated in the following way: first of all, during the same session, the VVF was cured by making a colostomy and then, after 2 months VRV was treated. Results. The follow-up took about 7.2 months; 62 patients (91.1%) recovered, for 6 cases treated only with transvaginal operation, it has been necessary a second surgical procedure owing to relapsing, and for 2 of them an abdominal muscle strip was used. Conclusions. In conclusion, while the transvaginal repair is satisfactory treatment for little fistula never surgically treated before, on the other hand the transabdominal vaginal treatment is the best cure forge large or relapsing fistulas.