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Gynecologic and plastic surgeons collaborate to improve vaginal reconstruction for women with vaginal stenosis and obstetric fistula. As these cases occur typically in low-resource settings, the Singapore flap is a useful technique given its reliability, safety, ease of dissection, and minimal need for additional supplies. The fasciocutaneous flap maintains cutaneous innervation and vasculature and does not require stenting. The surgical collaboration has made it possible to provide functional vaginal reconstruction as a part of the overall care of obstetric fistula patients. The technique shows promise for improving sexual function for women with obstetric fistula and may also enhance healing. Tweetable abstract Gynecologic & plastic surgeons collaborate to improve vaginal reconstruction for women with obstetric fistula.

Obstetric vesico-vaginal fistula remains a significant cause of female urinary incontinence worldwide. Approximately 2 million women suffer from this condition, perhaps many more, most of whom are in Africa. Very few centres are treating these patients, and although success rate in the closure of the fistula is high, up to 92%, this does not necessarily equate to a cure. A significant proportion of women remains with urinary incontinence. Little is known about the nature of this incontinence, and even less is known about how to manage it. This article describes a new and simple surgical procedure, which, when employed at the time of fistula closure, seems to reduce the incidence of residual incontinence in those women at a higher risk of developing it.

A 32-year-old female with a past history of pulmonary tuberculosis presenting with dribbling of urine per vaginam had a small fistulous opening in the anterior vaginal wall. Chest X-ray showed active tuberculosis. Right hydronephrosis and hydroureter with autonephrectomy of left kidney and vesico-vaginal fistula were demonstrated on intravenous urography. On cystoscopy, the bladder was contracted with two small fistulous openings. Cecocystoplasty and repair of fistulae were successfully done. Histology of bladder wall showed tuberculous cystitis.

A review of 840 bladder fistulae over 10 years revealed that 64 (7.6%) were giant vesico-vaginal fistulae. Association with vaginal stenosis and recto-vaginal fistulae were 23.4% and 4.6%, respectively. The results of direct one-stage repair were poor at 35% for the first attempt while the two-stage repair achieved 80% success at the first attempt. Advantages of the two-stage repair include change in the direction of repair for maximum protection of the terminal ureters and also the possibility of change in patient positioning and approach to the repair of the fistula after the first stage.