Trends of Genitourinary Fistula in Kigali, Rwanda, over a 10-year Period

Area of Science:

• Urology
• Gynecology
• Public Health

Background:

• Genitourinary (GU) fistula is a significant health issue, often resulting from prolonged labor or surgical complications.
• Developing nations face higher rates of ischemic fistula due to limited healthcare access.

Purpose of the Study:

• To analyze the causes and trends of genitourinary fistula in Rwanda over a decade (2013-2024).
• To compare characteristics and management of iatrogenic versus ischemic GU fistulas.

Main Methods:

• Retrospective review of 909 women diagnosed with GU fistula in Kigali, Rwanda.
• Classification of fistulas as iatrogenic (post-surgery) or ischemic (other causes).
• Analysis of surgical approaches, recurrence rates, and need for urinary diversion.

Main Results:

• 46% of fistulas were iatrogenic, 54% were ischemic.
• Iatrogenic fistulas had higher rates of abdominal repair and hysterectomies.
• Ischemic fistulas were more likely to require urinary diversion or present with recurrence.
• A significant annual increase of 2.1% in iatrogenic fistulas was observed.

Conclusions:

• There has been a notable rise in iatrogenic genitourinary fistulas in Rwanda, linked to obstetrical and gynecological surgeries.
• Management differs significantly between iatrogenic and ischemic fistulas, with implications for surgical approach and patient outcomes.