Post paum VVF is best repaired after :
3 months Vesico vaginal fistula . A Brief Review VVF -- is a communication between bladder and vagina.deg It is the M/C genito urinary fistula.deg It is an example of true incontinence.deg Causes In childhood : -- Penetrating trauma Foreign body Genito urinary surgery. In adults : Obstetrical causes Gynaecological cause Miscellaneous M/C cause in developing countries (India) -- Obstructed labour (M/C)deg - During LSCS -- Forceps delivery -- Use of Destructive instrumentsdeg -- Surgical aboion - Use of post-paum intravaginal caustic agents. M/C cause in developed countriesdeg-- is hysterectomy - Malignancy - Advanced carcinoma of cervix/vagina.deg - Radiation induced injury -- Infection (Rare) - TBdeg Syphilisdeg - LGV Actinomycosis -- At the time of inseion of IUCD -- Crush injury to pelvis in road accident -- Bladder calculi - Foreign body in genital tract (Rare) Symptoms : Patient gives history of continous escape of urine per vagina (true incontinence).deg Patient has no urge to pass urine.deg Besides this : patient may present with : Recurrent cystitis Hematuria Flank/suprapubic pain Inspection P/S examination Escape of watery discharge pervaginum with ammoniacal smell.deg Evidence of sodden/excoriated vulval skindeg Presence of greenish grey phosphate crystals on vulva and vagina.deg Patient should be kept in sims (knee/chest position and then P/S should be done If fistula is : Large - it is visible to naked eye Small - ask the patient to cough and bubbles of air can be seen coming out through the fistula. On Examination : Confirmatory tests : Methylene blue 3 swab test : (described earlier). Cystoscopy : To know exact location/size/number. Management : Surgical management : Timing of surgery Small urinary fistulas sometimes heal spontaneously during the first few weeks. However in a case of established fistula -it is better to wait for about 3 monthsdeg for all tissue inflammation to subside. If one attempt fails to heal fistula, second attempt is done after 3 months.deg In fistulas following radiation : 6 months to 2 years time can be taken before inflammation subsides. Techniques of Repair Latzko procedure Chassar Moir technique.deg Postop Management Continuous bladder drainage for 14 daysdeg. Antibiotic coverage. No vaginal examination, P/S, intercourse x 3 months. Avoid pregnancy for2 years. In pregnancy after repair of vaginal fistula - elective cesarean is done.deg Extra Edge : This question is an old one so here answer will be 3 months but if this question is repeated now remember the following lines from Williams Gynae. "Timing of repair :Traditional teaching recommends delayed repair of fistulas at 3 to 6 months afte injury. However this old dictum is probably no longer applicable. Most agree that unless there is severe infection of acute sign od information , waiting is not necessary. Early surgical intervention of uncomplicated fistulas does identified within the first 24 to 48 hours postoperatively can be safely repaired immediately with success rates of 90 to 100 percent."
6 weeks
8 weeks
3 months
6 months