Minimizing the urological and psychological morbidity of urinary tract fistulae from VBAC.
BACKGROUND
Because of the relative rarity of the condition, there is no consensus for the timing of surgical repair of fistulae following vaginal birth after Caesarean section (VBAC).


METHODS
Three cases of urinary tract fistulae following VBAC are presented. Two patients had an early repair (24-48 hours after delivery), and the third had a repair at four months after delivery. The surgical approach and intraoperative findings for the early and late repairs are described, and the psychological effects of early and late repair are compared. The early repairs were not technically difficult and were associated with less psychological morbidity.


CONCLUSIONS
In the absence of contraindications, early repair of urinary tract fistulae diagnosed within the first few days after VBAC delivery is preferred. If early repair is attempted, perioperative conditions must be optimized; urogynaecologic or urologic expertise and assistance should be considered.
Gilmour
Donna T
DT
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS.
Vallis
T Michael
TM
Lee
Winifred
W
Colford
Donald
D
Reardon
Edward
E
D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology* / Q000523:psychology / Q000601:surgery; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*