RESUMO
Twenty five patients with vesicovaginal fistulae were managed at St. Gaspar Hospital, Itigi, Tanzania between February 1993 and March 1994. Most of them, 92% were repaired vaginally routinely using the Martius labial flap and 8% were repaired transabdominally because the fistulae were inaccessible vaginally as they were vesicouterine or vesicocervical fistulae. The success rate was 96% after the first operative attempt.
PIP: Since there are no specialized fistula centers in Tanzania, fistulae are usually repaired in national referral hospitals where other surgical conditions are managed. Only a few small hospitals attempt the repair, forcing women from remote rural areas to travel long distances in search of treatment. St. Gaspar Hospital, in Itigi, however, is a small, rural facility which has offered the routine management of vesicovaginal fistulae (VVF) since February 1993. 25 patients with various sized VVF were managed at the hospital between February 1993 and March 1994. All patients had their fistulae confirmed by vaginal examination using a Sim's speculum. The VVF resulted in 96% of cases from prolonged or difficult labor, with the most common form of VVF being the very large fistulae, among 28%, followed by the big juxta-cervical fistulae, among 24%. Twelve patients were aged 15-24 years, while the remainder were aged 25-40. 92% were repaired vaginally routinely using the Martius labial flap. The remaining 8% were repaired transabdominally given the inaccessibility of vesicouterine or vesicocervical fistulae via the vagina. All patients were administered postoperative prophylactic antibiotics for five days and had indwelling catheters for 14 days. They were then discharged home one or two days after removal of the catheter with advice that they should abstain from sexual intercourse for three months, avoid pregnancy for one year, and deliver by cesarean section should they become pregnant. An outcome was considered successful when the patient left the hospital dry and remained so upon the follow-up visit 6-8 weeks later; the success rate was 96% after the first operative attempt.