Severe Post-Coital Harrowing Vesicovaginal Fistula – VVF

In third world countries obstetric distress persists as the chief reason behind VVF or Vesicovaginal fistula. Obstetric surgical intervention and irradiation additionally are the contributing factors to the occurrence of Vesicovaginal Fistula. The below stated uncommon case of VVF subsequent to coitus has been cited in the case of a woman in her post-menopause period. This is perhaps the first of its kind citing.

A near sixty year old post-menopause woman was hospitalised in the emergency section with a past of extreme bleeding from the vagina subsequent to intercourse. On physical examination, the woman looked pale, had tachycardia and low blood pressure.

Following revivifying with intravenous fluids, an examination of the vagina showed linear rip in the anterior fornix and accompanying blood and watery emission. The tip of the Foley’s catheter was detected in the vaginal cavity following catheterization. Under the influence of anesthesia, the tear in the vagina and the VVF were repaired. An examination undertaken under the influence of anesthesia showed an anterior forniceal rip.

The tear was even noted in the posterior wall of the bladder and the trigone. The duo ureteric maws were open to the vagina. During catheterization, 5F infant feeding tubes were employed on the duo ureteric maws and the rip in the bladder was secured in 3 layers using 4-0 catgut and 3-0 vicryl. The tear in the vaginal region was sealed using 2-0 vicryl. The catheters in the ureters were taken off after 7 days and the catheter inserted in the bladder was taken off on the tenth day after operation. The woman was later discharged after complete recovery. The lady was evaluated at three months subsequent to being discharged and was noted to be in fine condition.

VVF subsequent to intercourse is quite uncommon although it has been cited earlier. The trauma experienced is commonly reported quite belatedly and not right away. VVF subsequent to intercourse is a condition generally noticed in the younger age bracket of women. This report mentioned is the foremost case that has come about in a postmenopausal woman. The VVF transpired due to the shallow nature and tenting of the fornix in the postmenopausal phase, emaciated vaginal mucosa and forceful and brash coitus.

Severe traumatic VVF when secured on a prompt basis normally recuperates adequately. The solution to the restoration is correct recognition of the tissues and appropriate anatomical closing.

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