Ojewola Rufus Wale, Tijani Kehinde Habeeb, Jeje Emmanuel Ajibola, Ogunjimi Moses Adebisi, Animashaun Emmanuel Abayomi, Akanmu Olanrewaju Nurudeen
Department of Surgery, College of Medicine of University of Lagos; Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria.
Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria.
Niger Postgrad Med J. 2018 Oct-Dec;25(4):213-219. doi: 10.4103/npmj.npmj_154_18.
Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. Arguments continue as to the best approach for repair. This study aimed to present our experience with transabdominal VVF repair.
This was a 10-year retrospective review of transabdominal VVF repair. Important data extracted from the case notes included patients' demography, aetiology, previous repair, operative findings, procedures and treatment outcome. Data were analysed using SPSS version 21. Bivariate analysis of factors affecting treatment outcome was carried out with the level of significance set at P < 0.05.
Fifty-three VVF repairs were carried out in 51 patients. Mean age was 29.8 ± 15.4 years. Forty-five (84.9%) had previous repairs. The aetiologies of VVFs were prolonged obstructed labour in 41 (80.4%) and post-operative in 10 (19.6%). Forty-one repairs were through a transperitoneal transvesical approach whereas 12 had an extraperitoneal transvesical approach. The fistulae diameter ranged from 0.3 to 2.8 cm with an average of 1.64 cm. Six had ureteric re-implantation; (bilateral in two patients). Repair was successful in 47 (88.7%) cases, which translated to the overall success rate of 92.1% in the 51 patients treated. Success rate was higher (95.6%) for the subset of patients who had previous transvaginal repairs. Catheter blockage in the post-operative period was a significant factor that had effect on outcome (P < 0.015).
Transabdominal repair recorded an excellent result in patients who had previously failed transvaginal repairs and may be considered as the first option in these patients.
膀胱阴道瘘（VVF）在许多发展中国家仍是一个主要的关注问题。关于最佳修复方法的争论仍在继续。本研究旨在介绍我们经腹修复膀胱阴道瘘的经验。
这是一项对经腹膀胱阴道瘘修复术的10年回顾性研究。从病例记录中提取的重要数据包括患者的人口统计学、病因、既往修复情况、手术发现、手术步骤和治疗结果。使用SPSS 21版软件进行数据分析。对影响治疗结果的因素进行双变量分析，显著性水平设定为P<0.05。
51例患者共进行了53次膀胱阴道瘘修复术。平均年龄为29.8±15.4岁。45例（84.9%）患者曾接受过修复术。膀胱阴道瘘的病因包括41例（80.4%）产程延长梗阻性分娩和10例（19.6%）术后原因。41次修复采用经腹经膀胱入路，12次采用腹膜外经膀胱入路。瘘管直径为0.3至2.8厘米，平均为1.64厘米。6例患者进行了输尿管再植术（2例为双侧）。47例（88.7%）修复成功，在接受治疗的51例患者中总体成功率为92.1%。既往接受过经阴道修复术的患者亚组成功率更高（95.6%）。术后导管堵塞是影响结果的一个重要因素（P<0.015）。
经腹修复术在既往经阴道修复失败的患者中取得了优异的效果，可作为这些患者的首选方案。
