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Genital tract fistula: a case series from a tertiary centre in South Africa

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Abstract

Introduction and hypothesis

We describe the demographic profile, aetiology, management and surgical outcomes in women with genital tract fistula presenting to a tertiary urogynaecology unit.

Methods

This retrospective audit included 87 patients managed in our unit between 2008 and 2015. Frequencies and means with standard deviations are presented for categorical and continuous data. Continuous dependent variables are categorized as above or below the median for bivariate analyses performed using the chi-squared test (α = 0.05).

Results

The mean age of the women was 34.7 years, 64.4% were Black African, 70.2% were multiparous, 49.4% were married, 82.8% were employed, and 21.8% were HIV-infected, with 47.4% on antiretroviral treatment. Vesicovaginal (47.1%) and rectovaginal (41.4%) fistula were the most frequent injuries. The majority of the injuries (67.8%) were obstetric, with 26.4% occurring during caesarean delivery. Repair had been attempted previously in 43.7% of patients. In 63.2% of the repairs the approach was vaginal and in 35.6% abdominal. Interposition grafts were used in 23% of repairs. In 85.1% of patients the initial repair at our centre was successful. Patients with multiple repairs were more likely to have complications (p = 0.03). HIV infection was not significantly associated with complications.

Conclusions

A high rate of successful repair was found, with previous unsuccessful repairs associated with poorer outcomes, highlighting the need for centralized management.

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Acknowledgements

The authors are grateful to colleagues from both public and private Institutions, both within and outside KwaZulu-Natal, who referred their patients to our unit for management. The dedication of the nursing staff in the Urogynaecology Clinic, Gynaecology Ward and Operating Theatre of Greys Hospital to the care of these patients is gratefully acknowledged. Special thanks to the consultants, and the medical officers in the unit, who shared in the management of these patients. The courageousness and resilience of these patients under debilitating and devastating circumstances must also be acknowledged.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Greys Hospital, Pietermaritzburg, South Africa

    Thinagrin Dhasarathun Naidoo

  2. Nelson R Mandela School of Medicine, University of Kwa Zulu-Natal, Durban, South Africa

    Thinagrin Dhasarathun Naidoo

  3. Department Obstetrics and Gynaecology/Women’s Health, Nelson R Mandela School of Medicine, University of Kwa Zulu-Natal, Durban, South Africa

    Jagidesa Moodley

  4. Department of Public Health Medicine, School of Nursing and Public Health, University of Kwa Zulu-Natal, Durban, South Africa

    Saloshni Naidoo

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  1. Thinagrin Dhasarathun Naidoo
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  2. Jagidesa Moodley
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  3. Saloshni Naidoo
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Correspondence to Thinagrin Dhasarathun Naidoo.

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Naidoo, T.D., Moodley, J. & Naidoo, S. Genital tract fistula: a case series from a tertiary centre in South Africa. Int Urogynecol J 29, 383–389 (2018). https://doi.org/10.1007/s00192-017-3396-2

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  • DOI: https://doi.org/10.1007/s00192-017-3396-2

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