Circumferential urethral fistulae in Sub-Saharan Africa, current outcomes and future prospects

Circumferential urethral fistula is a severe form of obstetric injury that is recognized to carry a poor prognosis for eventual continence but this has not been quantified before.

An analysis of 106 women who had undergone primary repair of a circumferential fistula was carried out with particular reference to whether there complete continence or at least some improvement in remaining dry was reported.

Of the 106 women, only 25% reported themselves continent; 19% said there was an improvement. Prognosis was not altered by the distance of the fistula from the external urethral meatus, with 10/62 (16% reporting continence if the fistula was <1.5 cm and 10/44 (13%) if >1.5 cm. There was a 13% primary dehiscence rate.

Current methods of primary urethral fiistula repair carry a poor prognosis for eventual continence. Techniques to lengthen the urethra and provide greater support need to be developed for this unfortunate group of women.