Int Urogynecol J (2007) 18: 39–42 DOI 10.1007/s00192-006-0068-z ORIGINAL ARTICLE Neeraj K. Goyal . U. S. Dwivedi . N. Vyas . M. P. Rao . S. Trivedi . P. B. Singh A decade’s experience with vesicovaginal fistula in India Received: 2 August 2005 / Accepted: 13 January 2006 / Published online: 28 September 2006 # International Urogynecology Journal 2006 Abstract A retrospective analysis of 252 cases of vesico- vaginal fistulae was done to analyse its etio-pathology and management in an Indian population. After a thorough evaluation, different techniques of fistula closure were used for repair and the results were listed. The main outcome measures were the etiology of the fistula, need for tissue interposition and cure rate per repair as well as the overall cure rate. We compared our results with literature and concluded that simple and small fistulae should be repaired with layered closure. All complicated fistulae should be repaired with tissue interposition or tissue graft. This is the first study from India compiling 10 years of experience on vesicovaginal fistula. Keywords Vagina . Bladder . Hysterectomy . Fistula Introduction The Ebers Papyrus represents the first documented medical reference to vesicovaginal fistula (VVF). In 1935, Derry found a VVF in the mummified remains of Egyptian Queen Henherit (11th Dynasty, 2050 B.C.) [1]. VVF remains a challenging condition for uro-gynecologic surgeons. VVF is a physically, socially and psychologically devastating condition for the patient. It is among the most distressing complications of gynecologic and obstetric procedures. VVF is a major public health problem in developing countries. More than 80% of cases result from neglected obstructed labour, and the condition may follow 1–2 out of 1,000 deliveries, with an annual world-wide incidence of up to 500,000 cases [2]. VVF is the most common genitourinary fistula on account of obstetric and gynecologic risk factors. Obstetric risk factors include obstructed labour due to unattended deliveries, small pelvic dimensions, malpresentations, poor uterine contraction and introital stenosis. Gynecologic risk factors include hysterectomy, extensive dissection between bladder and vagina, unrecognised bladder laceration, inappropriate stitch placement, and/or devascularisation injury to the tissues. The most common location of VVF after hysterectomy is at the vaginal cuff and the supra-trigonal area on the posterior wall of the bladder, as this is the usual site of bladder injury during surgery [3, 4]. VVF that develops after obstructed labour usually involves the bladder base, trigone and urethra [5]. VVFs are classified as simple and complicated. Com- plicated fistulae are fistulae of large size (greater than or equal to 3 cm in diameter); those recurring after prior attempts at closure; those associated with a history of prior radiation therapy or with malignancy; those occurring in a compromised operative field owing to poor healing or host characteristics and those involving the trigone, bladder neck and/or urethra [1]. For the purpose of our study, we categorise simple fistulae as small-sized fistulae, i.e. less than 1 cm in diameter, and medium-sized fistulae, i.e. 1–3 cm in size. The aim of our study was to define the etiology and management strategies of VVFs and to evaluate the results of different techniques utilised for the repair of these fistulae. Patients and methods Our institute is a tertiary health care referral centre. From February 1995 to February 2005, 327 cases of genitouri- nary fistulae were repaired. Of these cases, 40 were lost to follow up and 35 were of other genitourinary fistulae (urethrovaginal fistulae, uterovesical fistulae, ureterovaginal fistulae and fistulae involving the bladder neck and urethra where bladder neck and/or neo-urethra reconstruction was required). These 75 cases were excluded from the study, and N. K. Goyal . U. S. Dwivedi . N. Vyas . M. P. Rao . S. Trivedi . P. B. Singh (*) Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, India e-mail: bhuurology@yahoo.co.in Tel.: +91-542-2307351 Fax: +91-542-2313200 e-mail: drneerajg@yahoo.com