A Fictitious Replicated Display about the Effect of Physiotherapy and Health Education Programs on the Surgical Repair of Vesico-Vaginal Fistula

Objectives: Surgery is the only effective therapy for the majority of Vesico-Vaginal (V-V) fistulae. The current research assessed the effect of a planned program of pre- and postoperative physiotherapy and health education on the outcome of V-V fistula surgery. Methods: We examined the postoperative outcomes of two groups of women with V-V fistulae recruited and followed up on by two local nonprofit organizations at a hospital in Saudi Arabia on April-October 2021. The first group of women (n = 99) underwent fistula repair using conventional procedures. The second group (n = 112) had a standardized surgical technique as well as a systematic pre- and postoperative health education and physiotherapy regimen. Results: The training had a strong favorable influence on overall recovery and urine incontinence in particular. The chances of recovery after physiotherapy were 2.7 times higher for women in the physiotherapy group than for control patients, and the likelihood of postoperative stress incontinence was significantly higher for patients in the control group than for those in the physiotherapy group (P value 0.001). Conclusion: A planned program of health education and physiotherapy provided by skilled nurses and physiotherapists increases the chance of a satisfactory result after V-V fistula repair surgery.

Vesico-Vaginal Fistula Repair by a Vaginal Approach

<b><i>Introduction:</i></b> The aim of this study is to determine the outcome of surgically treated vesico-vaginal fistulae (VVaFs) using a transvaginal approach with a Latzko technique. <b><i>Methods:</i></b> A retrospective chart study was conducted at the Department of Urology, Radboud University Medical Centre. Surgical approaches to repair VVaF, from 2014 to September 2020, were selected. Patients who underwent a transvaginal approach were included. The primary objective was fistula closure. Secondary objectives were predictive factors for the outcome of the surgical procedure, for example, patient characteristics, leakage on cystography 2 weeks postoperative, and surgery time. <b><i>Results:</i></b> Thirty-one patients had surgery for VVaF. Twenty-five procedures (81%) were performed transvaginally. Thirteen of these (52%) had successful transvaginal closure after the first attempt. Seven out of 12 had their second attempt at the time of analysis, of which 4 (57%) were successfully closed thereafter. After either 1 or 2 attempts with the transvaginal approach, 17 (68%) of the VVaFs were successfully closed, but 79% if patients who did not yet had a second attempt were taken into account with the current success extrapolated. Only few minor complications were observed. <b><i>Conclusion:</i></b> Transvaginal closure of VVaFs with a Latzko technique is successful in about 79% in either 1 or 2 attempts, with few minor complications. A second attempt in closing the fistula with a transvaginal approach is useful, and a previous transvaginal attempt is not a contraindication for a second transvaginal attempt in closing the VVaF surgically.

Interposing layer of fibrin glue: A new horizon in vesico-vaginal fistula repair

Aim: In this study our idea is to compare the effectiveness of using interposing layer of fibrin glue to omental flap in reducing the failure of laparoscopic vesicovaginal fistula repair. Methods: Forty patients with fairly large vesicovaginal fistula were enrolled and divided in two groups of 20 each. We have used fibrin glue in one group and omental flap in the other group. Result: Of 20 patients in fibrin glue group no failure was seen, while 5 patients out of 20 in omental flap group had failure. Conclusion: This result is statistically significant and hence use of fibrin glue to be considered during laparoscopic repair of vesicovaginal fistulas.

Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study

Background Obstetric fistula (OF) complicated by urethral loss (UL) poses a challenge to both the fistula surgeon and obstetric fistula patient. The involvement of the urethra and urethral closure mechanism in OF is an important determinant of successful closure of fistula and restoration of urinary continence. OF with UL is often associated with unsuccessful repair outcome. We describe urethral reconstruction in genital tract fistula patients with UL and the outcomes of the repair. Methods Aim To review the clinical characteristics and outcome of vesico-vaginal fistula associated urethral loss following urethral reconstruction. This was a descriptive cross-sectional study conducted at the University College Hospital, Ibadan, Nigeria. A 5-year prospective data of all vesico-vaginal fistula patients with urethral loss (2011–2016) were reviewed and analysed. Data collected include socio-demographic and obstetric characteristics; cause of the fistula; and fistula characteristics—type of fistula, number of previous repairs, urethral loss, outcome of repair and follow-up. Data were entered and analysed using IBM SPSS version 20. Results Urethral loss occurred in 23 (15.3%) out of 150 women with OF; these women had urethral reconstruction surgery. The commonest type of urethral loss encountered in this cohort was proximal urethral loss which was seen in 12 (52.2%) patients. The most common types of fistula seen with urethral loss were large vesico-vaginal fistula (34.8%) and mid-vaginal fistula (26.1%). More than half of the women (56.6%) had previous unsuccessful repair at other facilities before presentation. The fistula closure rate was high (82.6%) regardless of type of urethral loss. Among the women with successful closure of OF with UL, about 36.8% had urinary stress incontinence post-fistula repair. Conclusion Urethral loss appears to be a rare complication of obstetric fistula. Successful closure with stress incontinence was seen in a sizeable number of women with OF with UL. Preoperative assessment for determinant of post-repair incontinence and surgical repair by experienced surgeons will improve successful outcome of repair in women with obstetric fistula with UL.