Aims: Obstetric fistula can be complicated by bladder calculus. The mechanism of lithogenesis is caused by some predisposing factors. The article aims to describe risk factors predisposing to bladder calculus formation and repair outcome. Methods: This was a comprehensive retrospective review from medical records of fistula obstetric repairs associated with bladder calculus at Saint Joseph Hospital in Kinshasa, DR Congo, from January 2007 to December 2017. Results: Among 1416 women who had had obstetric fistula, 30 (2.12%) had bladder calculus. The average age of women was 38 years old and ranged between 22 and 82 years old. The average duration of fistula was 8 years and ranged from 5 months to 31 years. All fistulas were iatrogenic and 86.67% (n = 26) occurred after caesarean section. Size of calculus varied between 1 cm and 15 cm. Risk factors identified were: urinary tract infection 80% (n = 24), foreign bodies 13.33% (n = 4), malnutrition and dehydration in 33.33%. In majority of cases (90%), the removal of the calculus and repair of fistula were performed at the same time by transvesical way. 70.37% of the patients had successful repairs. Conclusions: Iatrogenic fistula after caesarean section, urinary tract infection and foreign bodies are related to the formation of bladder calculi. Fistula repair and extraction of bladder calculus performed at the same time gives good results. Access to Obstetric Emergency Care, qualified personnel and available infrastructure and equipment are important for the prevention of the occurrence of bladder calculus.
Aims: To describe the frequency and management of non-obstetric fistula (NOF) in Democratic Republic of Congo (DRC). Methods: A retrospective cohort study reviewed patients’ medical records in three fistula repair sites supported by the USAID-funded Fistula Care Plus (FC+) Project, covering 1 January 2015 to 31 December 2017. Study variables included demographic characteristics, fistula etiology as reported by surgeon, fistula type (Waaldijk classification), and treatment outcomes. Results: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three sites, 384 (19%) were considered to be NOF cases. 91% of these women resided in rural areas. 49.3% were married/in relationship at time of treatment compared to 69% before the fistula (p<0.001). Most (n=316; 82.3%) had no previous repair attempts and 96.2% had an intact urethra. Type III (n=247; 64.3%) and type I (n=121; 31.5%) fistulas (Waaldijk classification) were most common. The main causes of NOF were medical procedure (n=305; 79.4%), congenital origin (41; 10.7%) or sexual assault (28; 7.3%). Caesarean section (n=234; 76.7%) and hysterectomy (n=54; 17.7%) were the most common causative procedures. 369 women with NOF received surgical repair (96%), mainly through routine services (n=317; 85.9%). At discharge, 353 women were closed and dry (95.7%) and 11 were closed with residual incontinence (3.0%). Conclusions: NOF, particularly due to iatrogenic causes, was relatively common in DRC. Surgical repair at FC+-supported sites led to good clinical outcomes. However, to achieve a fistula-free generation in DRC, prevention of iatrogenic fistula is needed, requiring improved quality of maternal care.
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