[Uro- and enterovaginal fistulas]

Gynecological fistulas that cause faecal or urinary incontinence, represent a considerable global health problem that usually reflects inadequate help at birth. The problem has a different profile in the more industrialised countries. The aim of the present study was to characterise gynaecological fistulas in a Norwegian setting.

Data (medical history, type of fistula, treatment and outcome) were recorded from women assessed and treated for uro- and enterogenital fistulas in 1995-2005 at the Woman's clinic Haukeland University Hospital.

Of 82 women, 21 were assessed for uro- and 61 for enterogenital fistula. The verified urogenital fistula (19/21) were mainly caused by surgery (16) and only one came after birth. 17 patients required operative closure. Birth (20) and surgical procedures (17) were the main causes of the 54/61 verified enterogenital fistulas. Cancer (9) and inflammatory bowel disease (14) were important contributing diseases. So far 40 patients have been cured, 38 by surgery. Median time from symptoms to diagnosis seven weeks (range 1 day to 10 years) for urogenital and 15 weeks (range 3 days to 3 years) for enterogenital fistulas.

Obstetrical fistulas represent 1/3 of the vaginal fistulas treated in our department, but in contrast to the developing world, these lesions are mainly enterovaginal. Surgery, cancer and inflammatory bowel diseases comprised the rest of the fistulas. Urovaginal fistulas comprised 1/4 of all fistulas and were almost exclusively caused by surgery. For many patients it took a long time before they received a diagnosis.