Outcome of Surgical Repair of Vesicovaginal Fistula-A Comparative Study between Transabdominal and Transvaginal Route

Background: The management of VVF involves a multi-modal technique. Surgical repair remains the treatment of choice for VVF. The repair could be undertaken through the transabdominal or transvaginal route. Although the vaginal route was the commonest route employed in the repair of VVF, it is clearly associated with post-operative incontinence, high recurrence and low success rate. Objectives: To compare the outcomes of surgical repair of vesicovaginal fistula between transabdominal and transvaginal Route. Methods: This prospective comparative study intended to compare the outcomes between surgical repair of vesicovaginal fistula- between transabdominal and transvaginal route. A total of 50 cases of VVF patient planned for surgical repair of VVF in Dhaka Medical College Hospital from April 2017 to September 2018, included in this study according to the inclusion and exclusion criteria. Cases were randomly allocated to group A (Transabdominal repair of VVF) and group B (Transvaginal repair of VVF). Each group consisted of 25 patients. The outcome variables were success rate of operation, post-operative complication, post-operative pain, post-operative hospital stay and recurrence. Data were analyzed and compared by statistical tests. Results: No significant differences were found regarding age (p=0.3921), etiology (p=1.000), fistula number (p=0.4174), haematuria (p=0.667), vaginal bleeding (p=1.000), wound infection (p=0.4174) and hospital stay (p=0.4828) between two groups. Post-operative incontinence (p<0.0448) was less in group A than group B cases. Success rate is higher in group A in comparison to group B (p<0.0223). Conclusions: Trans-abdominal route is better than trans-vaginal route in VVF repair. It significantly reduces post-operative incontinence and recurrence of VVF. Success rate is also high in trans-abdominal route than trans-vaginal route. So, VVF repair by trans-abdominal route is safe and effective.