Repair of Extensive and Complicated Vesicovaginal Fistulae with Segment of Ileum or Ileocecum for Augmentation Cystoplasty

Vesicovaginal fistula is a complication of difficult labor or operation on female genital tract. Various methods have been used to repair the extensive and complicated vesicovaginal fistulae. The aim of this study was to evaluate the effect of using ileal or ileocecal segments to repair extensive vesicovaginal fistulae and augment contracted and fibrotic bladders in patients with history of unsuccessful previous repairs. Methods and Material: From March 1989 to January 2005 more than 87 patients with vesicovaginal fistulae were operated on in the urology center, Imam Reza Hospital affiliated to Mashhad University of Medical Sciences. Of them, seven patients had extensive vesicovaginal fistulae with fibrotic and contracted bladders. All of the seven patients had the history of several previous unsuccessful operations to treat their fistulae. For six out of the seven patients, after closing the fistulae augmentation cystoplasty were performed using a segment of detubularized ileum. In the remaining one patient we used ileocecal segment for augmentation and the appendix as conduit.

Mean age of the patients were 46.3 (±SD=11.2). Mean follow-up was 38 months (range:14–76 months). No early complications were seen but in one patient with the appendix as conduit, 3 years after the operation several stones were formed in the reconstructed bladder. Four patients could void normally and did not have significant residual urine; however the other three patients had significant residual urine and needed clean intermittent catheterization twice daily. None of the patients had urinary incontinence during the follow-up period.

In patients with extensive vesicovaginal fistulae with contracted and fibrotic bladder, augmentation cystoplasty is an effective method to salvage the remnant bladder and to treat the urinary incontinence.