Xu Kexin

Repair of a small and crooked vesicovaginal fistula using electrocauterization

Vesicovaginal fistula (VVF) is an abnormal opening between the urinary bladder and the vagina. The condition has an immense psychological effect on patients due to the continuous leakage of urine or watery vaginal discharge. The wet feeling and foul smell associated with leakage of urine cause social outcasting of the patients. This leads to immense emotional trauma and makes life miserable for the patient. The most common etiology for VVF in developing countries is obstructed labour [1], and in developed countries, it is abdominal hysterectomy [2]. VVF poses a challenging problem to the surgeon. The location and the size of the fistula determine the extent of the patients’ symptoms. The transvaginal and abdominal routes (open, laparoscopic, or robotic) are the two approaches currently in vogue for the repair of VVF. However, some surgical procedures for fistula repair may worsen the situation for these patients. The appropriate surgical procedure needs to be chosen based on the particular condition of the fistula. The two patients in our research study, who have a small and crooked VVF, showed a poor prognosis after a cystoscopic holmium laser ablation. Therefore, electrocauterization was tried on them. The objective of the present study is to describe the management of a small and crooked VVF using electrocauterization, with the specific aims of avoiding the disadvantages associated with using the abdominal route, thereby minimizing the surgical trauma andmaximizing the prognosis. Two women admitted to Peking University People’s Hospital with vesicovaginal fistula were recruited for this study. The demographic information of the patients was shown in Table 1. They had a history of multiple uterine fibroids and endometriosis and underwent a hysterectomy. The patients developed continuous dribbling of urine 1 month after the operation, which was associated with position change and an increase of abdominal pressure. Physical symptoms and any illness were assessed prior to surgery. A speculum examination of both patients did not