Genito-urinary fistula: a major morbidity in developing countries

Area of Science:

• Obstetrics and Gynecology
• Surgical Urology
• Public Health in Developing Countries

Background:

• Urogenital fistulas, predominantly vesico-vaginal fistulas (VVF), are a major health concern for women in developing countries.
• Prolonged obstructed labor due to poor obstetric care is the leading cause, causing severe complications.
• This study reviews genitourinary fistula cases to understand the problem's magnitude and etiology.

Purpose of the Study:

• To analyze the characteristics, risk factors, and surgical management of genitourinary fistulae.
• To share surgical repair experiences with specialists in the field.
• To determine the prevalence and common causes of fistulas in the study population.

Main Methods:

• A descriptive study reviewing case records of 278 patients managed between June 1996 and December 2007.
• Data collected included patient demographics, risk factors, and surgical interventions.
• Statistical analysis using SPSS calculated means, ranges, standard deviations, and percentages.

Main Results:

• The mean age of patients was 31.5 years, with a mean parity of 4.2.
• Obstructed labor (88.4%) was the primary cause, followed by gynecological surgeries (9.35%).
• Vesico-vaginal fistulas (89.9%) were most common; 97.3% were repaired transvaginally with a layered closure technique, achieving success rates of 85% on the first attempt, increasing to 96% by the third.

Conclusions:

• Urogenital fistulae are a significant problem in Pakistan, largely due to poor obstetric care and prolonged obstructed labor.
• All types of urinary fistulae can be effectively repaired using fundamental surgical principles.
• Successful surgical outcomes are achievable even after multiple repair attempts.