Vesicovaginal fistula repair in the developing world: A call to action

Problem: Prolonged obstructed labor often creates a devastating gynecological injury known as vesicovaginal fistula (VVF) in which an abnormal connection between the vagina and bladder results in urinary incontinence. Women who suffer from VVF are debilitated and experience immeasurable suffering, which has created a public health crisis in the developing world. Little research is dedicated to this topic and to date there remains no standard of care for these patients. Methods: An extensive literature search using PubMed.gov was conducted to search for articles pertaining to obstetric and vesicovaginal fistula repair. Results: A total of 23 articles were identified and reviewed in this study. Multiple classification systems have been proposed, however, are merely descriptive, lacking consistent data, and are, therefore, ineffective at improving surgical outcomes. Conclusions: A universal classification system for VVF is a critical component in the advancement of VVF repair and is crucial for adequate communication amongst providers and researchers. Until such a system exists which correlates the degree of defect with surgical outcome and prognosis, the advancement of this field of medicine remains limited. The lack of standardized and reliable data makes retrospective analysis difficult, calling for a new approach. The suffering of these patients must be addressed and assistance provided to those dedicated to this cause.