84 NJOG / VOL 15 / NO. 1 / Issue 30/ Jan - Jun, 2020 Nep J Obstet Gynecol. 2020;15(30):84-85 Case Report Vesicovaginal Fistula Post Caesarean Hysterectomy Manisha Maharjan, Aruna Karki, Ganesh Dangal, Hema Pradhan, Ranjana Shrestha, Rekha Poudel, Nishma Bajracharya, Shreena Shrestha, Kenusha Devi Tiwari, Sonu Bharati Department of Obstetrics and Gynecology, Kathmandu Model Hospital, Nepal Received: November 12, 2019 Accepted: March 15, 2020 ABSTRACT Genitourinary fistula is an abnormal communication between the urinary tract and genital tract, most common being the vesicovaginal fistula. In most of the cases fistula results mainly due to poor obstetric care in developing countries, where as in developed countries most of the urogenital fistulas are iatrogenic. It is mainly diagnosed by clinical examinations and intravesical dye test using methylene blue. Repair can be done via abdominal or vaginal route based on the findings. Here we present a case of 27 years postnatal mother referred to our centre with diagnosis of vesicovaginal fistula post cesarean hysterectomy that was repaired successfully via vaginal approach. Keywords: cesaerean hysterectomy, urinary leakage, vesicovaginal fistula Citation : Maharjan M, Karki A, Dangal G, Pradhan H, Shrestha R, Poudel R, et al. Vesicovaginal Fistula Post Caesarean Hysterectomy. Nep J Obstet Gynecol. 2020;15(30):84–85. DOI: 10.3126/njog.v15i1.29351 CORRESPONDENCE Dr. Manisha Maharjan Paropakar maternity and Women Hospital, Kathmandu, Nepal Email: manishamaharjan672@gmail.com: Mobile: +977-9808556088 INTRODUCTION Vesicovaginal fistula (VVF) is an abnormal communication between the urinary bladder and the vagina resulting in an involuntary leakage of urine from vagina. 1 Lahore. Study Design: An observational study. Place and Duration of Study: Lady Willingdon Hospital, Lahore, from January 2007 to December 2008.\nMethodology: All cases of VVF treated at the centre during the study period were included in the study. The patients were admitted and evaluated through detailed history, physical examination, relevant investigations and evaluation under general anaesthesia (EUA Fistulas are a recurring problem in areas where women have inadequate access to quality emergency obstetric care in developing countries, affecting patient’s medical, physical, mental, social and sexual life. 2 It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. Iatrogenic postoperative VVF is the most common in developed countries, compared to mainly obstetric trauma in developing countries. 3 The physical and psychological impact of constant urinary incontinence from VVF can be overwhelming because of the burden of continual wetness, undesirable odors, vaginal and bladder infections and associated discomfort. The success rate has been associated with etiology of fistula, site of fistula, size of the fistula and number of previous failed attempts at repair. 4 CASE A 27 years postnatal woman referred-in to our center for VVF repair with history of continuous leakage of urine since her 20 th postpartum day following caesarean hysterectomy who didn’t respond on indwelling catheter for three weeks. She had undergone emergency caesarean section 6 months ago for placenta previa with previous LSCS and had caesarean hysterectomy for intractable PPH. Diagnosis was reconfirmed by per speculum and methylene blue dye test, and abdominal ultrasound was normal. Under subarachnoid block, she was evaluated, a fistulous opening around 2*2 cm was noted at vault. Wide dissection of fistulous margin was done, followed by mobilization of urinary bladder, margins freshened and edges approximated in layers with vicryl 2-0 suture. Dye test repeated following