[Obstetrical vesico-vaginal fistula. Report of 114 cases]

Obstetric vesico-vaginal fistulas are frequent in North Africa. The objective of this paper is to analyse the epidemiologic and therapeutic factors, basing our study on 114 cases of vesico-vaginal fistulas.

From February 1989 to December 1998, 114 patients with a mean age of 33 years (range: 17 to 76 years) were admitted to the department of urology for urogenital fistulas, classified as a function of the site of the fistula into 3 types, according to Benchekroun's classification: type I: urethrovaginal fistula (39.96%); type II: cervicovaginal fistula (11.40%); type III: vesicovaginal fistula (52.63%). Investigation of each patient comprised complete physical examination with laboratory and radiological assessment. Treatment was only performed after a minimal period of 3 months.

The majority of fistulas occurred in young multiparous women living in rural zones, predominantly due to an obstetric aetiology (87%). 183 reconstructive operations were performed in 114 patients, i.e. 1.73 operations per patient. Cure was obtained in 87 patients (76.3%) with 37% for type I, 92% for type II and 100% for type III. Twelve intermediate results (fistulas were closed, with persistent stress incontinence or frequency) and 16 failures (persistence of a residual fistula or need for urinary diversion) all concerned type I fistulas.

It appears that VVFs represent a public health problem in North Africa and that their surgical treatment is still technically difficult.