Causes and Management of Urogenital Fistula

Abstract

Objective: To audit the causes and management outcome of urogenital fistula (UGF) at LadyWillingdon hospital.
Study Design: A prospective descriptive study.
Place and Duration of Study: The department of obstetrics and gynecology Lady Willingdon Hospital Lahore from July 2009 to July 2010.
Patients and Methods: All patients of urogenital fistulae except due to malignancy and radiation were included in the study. History of demographic features, cause of fistula and previous attempts at surgery was taken. Investigations included urine culture, intravenous pyelogram and examination under anesthesia. The method of treatment and outcome was noted.
Results: 61 patients were included in the study. The formation of Urogenital fistulae was found to be more common in women of child bearing age (96.72%). Most of the patients belonged to lower socioeconomic group (100%) and to the rural areas (95%). The causative factor was obstetrical trauma in 43 (70%) cases, due to either obstructed labor (37.7%) or cesa-rean section (32.78%). Other causes were gynecological surgeries like abdominal hysterectomies (27.87%) and septic indu-ced abortion (1.63%). Surgical repair was performed in 58 patients. Overall success rate of different procedures was 77.04%. Vasicovaginal fistula (VVF) was found to be most common type of fistula. 43 / 61 patients (70.49%) had VVF. Repair of VVF was successful in 81.39% cases. Six patients out of 43 VVFs, had fistula of short duration and had a trial of conserva-tive management. Success rate was 50% in patients managed conservatively. Uretrovaginal fistula was found in 5 cases (8.2%) with 100% successful repair. Urethrovaginal fistula was found in 3 (4.92%) cases with no success through combined abdominovaginal route. All the three cases of Vasicouterine fistula (4.92%) were repaired abdominally with success rate of 66.67%. There were 7 cases of vasicocervical fistula (12.47%). Vaginal repair was performed with 71.43% success rate.
Conclusion: Vasicovaginal fistula was the commonest type of urogenital fistula. Transvaginal route was most successful route of repair for VVF.The commonest cause was obstetrical trauma which was preventable by improvement of health edu-cation and maternity care in rural areas.
Key Words: Fistula. Urogenital fistula. Vasicovaginal fistula. Urethrovaginal fistula, Obstetrical trauma.