Observations on aetiology and management of genital fistulas

We evaluated the aetiological factors and outcome of the management of genital fistulas. A review of patients who presented with genital fistulas between January 1998 and June 2002 was performed.

There were 34 cases of various genital fistulas, including 29 urinary and 5 intestinal fistulas. Among them 14 (41.2%) were attributed to obstetrical causes, 11 (32.3%) to gynaecological surgery, and 9 (26.3%) to other factors like vaginal procedure, coitus, trauma, etc. We had an operation success rate of 85.7% (30 out of 35 repairs). The success rate was 85.71% (24 out of 28) after primary and 83.3% (5 out of 6) after secondary repair (p=1.00). Vaginal repair was done in 28 cases whereas abdominal repair was carried out in 7 cases. The failure rate was 7.14% (2 out of 28) using the vaginal route and 42.8% (3 out of 7) using the abdominal route (p=0.05). The average duration of disease was 11.8+/-4.9 months vs. 30+/-10.3 months (p=0.5), the mean size of the fistulas was 1.5+/-1.0 x 1.3+/-0.9 cm vs. 2.4+/-1.9 x 2.2+/-1.8 cm (p=0.02) in successful and failed cases respectively.

The vaginal repair of fistulas is associated with a higher success rate. Fistulas due to other etiological factors specifically associated with genital malformation, like vaginal procedures and coitus, have the worst prognosis. Larger or longer duration fistulas are associated with poorer prognosis.