Genitourinary Fistula: An Indian Perspective

Abstract

Background In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed. Purpose The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature. Materials and Method During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database. Result Mean age of the patient was 27 years (range 16-51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active. Conclusion Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.

Surgical outcome of genito-urinary obstetric fistulas (GUOF) with or without bladder neck involvement: an experience from the University Teaching Hospital, Yaoundé, Cameroon

“…The average age in both study groups was 26±8.02 years, similar to reports from Africa and Asia with the mean age at treatment around 25-29. [22][23][24] Proportion of unmarried women (65.2%) was higher than that of 40 to 50 % reported by others. 25,26 The majority of patients in both study populations had primary level of education (54.3%).…”

Rising trends in iatrogenic urogenital fistula: A new challenge

“…A study from Ethiopia (2011–2015) reported that among 2500 fistula cases, 24.6% were attributed to surgical cause, particularly cesarean delivery and hysterectomy . An Indian study conducted from 2007 to 2013 reported that 39% of genitourinary fistulae were iatrogenic . A further study, conducted from 2011 to 2015 in India, reported that 65% of fistula cases were iatrogenic .…”

Common Genitourinary Fistulas in Rural Practice: Treatment and Management

“…Obstructed labor is the main cause of VVF in the rural areas accounting for between 56 and 97.88% in some series [4,[12][13][14][15][16].…”

“…The surgical residents at the Federal Medical Center Owerri, Nigeria perform circumcision under the supervision of team consultants since 2000. The less commonly occurring vesicouterine fistula (VUF) and vesicocervical fistula are complications of difficult cesarean sections (CS) [16], and uterine rupture. When urinary fistula occurs as a complication of treatment the effect is devastating to the trained care giver even though the propensity for medicolegal litigation is very low in the rural areas.…”

“…The risk factors related to the development of urogenital fistulas in the rural areas that appear in the literature, [7,12,14,16,23] are enumerated in Table 3. Other factors especially in the developed world include periurethral bulking, Burch Culpo suspension, urethral diverticulum repair, and loop excision of the cervix [24][25][26][27][28].…”