A single step transvaginal surgery in managing vesicovaginal fistula with grade III cystocele in post hysterectomy patient: A case report and literature review.

INTRODUCTION: Vesicovaginal fistula (VVF) is a persistent issue, particularly after obstetric surgeries such as hysterectomy. Complications like pelvic organ prolapse (POP) and underactive bladder often occur (Barber and Maher, 2013; Rajaian et al., 2019). Women with both VVF and cystocele experience reduced quality of life and psychological challenges (Alio et al., 2011). This case report highlights the management of a woman with VVF and cystocele following hysterectomy.

CASE PRESENTATION: A 53-year-old woman presented with urinary incontinence and a vaginal bulge two years post-hysterectomy. She had type 2 diabetes mellitus and obesity but had not sought prior treatment. Examination revealed urinary incontinence and grade III cystocele. She underwent one-step transvaginal surgery with two weeks of postoperative catheterization. After catheter removal, no urinary leakage or prolapse was observed, significantly improving her quality of life.

DISCUSSION: VVF with cystocele post-hysterectomy is rare, accounting for only 1 % of complications (Njoku et al., 2016). Symptoms include continuous urinary leakage (Lee et al., 2012). Treatment options vary from conservative to surgical approaches (Lee and Zimmern, 2019). In this case, single-step transvaginal surgery resulted in positive outcomes, improving the patient's condition (Hadzi-Djokic et al., 2009; Mancini et al., 2021).

CONCLUSION: Concomitant VVF and cystocele are rare but significantly impact women's health. Single-stage transvaginal surgery offers cost-effective and favorable results, reducing the need for multiple procedures. This case adds valuable insight into the management of such cases.