BRIEF COMMUNICATION Early versus late closure of vesicovaginal fistulas G.S. Melah * , A.U. El-Nafaty, M. Bukar Department of Obstetrics and Gynecology, Federal Medical Centre, Gombe, Gombe State, Nigeria Received 9 November 2005; received in revised form 21 February 2006; accepted 23 February 2006 Vesicovaginal fistulas (VVFs) have become rare in the industrialized world, but they still commonly occur in developing countries [1]. It was reported at an international workshop in Nigeria in 1998 that more than 2 million women are affected with a VVF [2] and that most of them are younger than 20 years—some as young as 12 years [3]. The present observational study was carried out in an environment where VVF is prevalent to determine whether timing matters for satisfactory VVF repair. Eighty women consecutively treated for a VVF at Federal Medical Centre, Gombe, Nigeria, between January 1, 2001 and December 31, 2003, under- went surgery before 12 weeks (early) or after 12 weeks (late) after acquiring the fistula. Of these women, 41 (51.3%) presented early and 39 (48.7%) presented late for fistula repair. Outcomes were analyzed using the Epi Info software, version 3.3 (provided by the Centers for Disease Control and Prevention), with v 2 N 1 considered significant. The local ethics committee approved the study. Age ranged from 12 to 45 years (mean: 19.3 years) and 52 women (65.1%) were younger than 20 years. Mean parity was 1.2 (67 women [83.8%] were primiparas), only 3 (3.8%) had received a primary education, and 78 (97.5%) were from a low social class (laborers and subsistent farmers). As reported previously, prolonged obstructed labor was the leading cause of fistula in 76 (95.0%) of the women [1,4] and 8 women (10.0%) also had rectovaginal fistulae. Other vaginal con- ditions caused by a dystocic delivery were vaginal shortening or stenosis, damage in the pubococcy- geus muscle and partial labial loss. The fistulas were commonly larger than 5 cm (range: 0.5—8.0 cm), and had been acquired between 2 and 11.2 weeks previously (mean: 7.4 weeks) in the bearly repairQ group and between 12 and 840 weeks (mean: 75.2 weeks) in the blate repairQ group. Repair outcomes are shown in the Table 1. Successful closure at the first surgical attempt was 36 (87.8%) in the early repair group vs. 34 (78.0%) in the late repair group. Among the 36 women who underwent successful closure in the early repair group, 32 (82.9%) 0020-7292/$ - see front matter D 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. doi:10.1016/j.ijgo.2006.02.017 * Corresponding author. Tel.: +234 72 221453; fax: +234 72 223411. E-mail address: gsmelah@hotmail.com (G.S. Melah). KEYWORDS Vesicovaginal fistulas; Early repair; Late repair International Journal of Gynecology and Obstetrics (2006) 93, 252 — 253 www.elsevier.com/locate/ijgo