A 26-year-old woman develops a vesicovaginal fistula (VVF) following prolonged obstructed labour. She presents 3 weeks post-partum with constant urinary dribbling. The MOST important initial step before planning surgical repair is:

• A Immediate surgical repair within 72 hours
• B Intravenous antibiotics for 2 weeks then repair
• C Cystoscopy and ureteric stenting as primary treatment
• D Conservative management with continuous bladder drainage for 4–6 weeks to allow spontaneous healing and inflammation resolution ✓

Explanation

Obstetric VVF repair should be delayed until the acute inflammatory oedema and necrosis have fully resolved, typically 3–6 months after injury in high-resource settings. However, early repair (6–12 weeks) is now acceptable in uncomplicated small fistulae with healthy tissue edges. Continuous bladder drainage for 4–6 weeks allows: resolution of oedema, demarcation of necrotic tissue, optimisation of tissue vascularity, and spontaneous closure of small fistulae (up to 15% close conservatively with catheter drainage). The answer reflects standard teaching about initial conservative management before surgical planning.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.