Surgical repair of genitourinary fistulae: comparison of our experience at Turkey and Niger
- 118 Downloads
Report of the personal experience at repairing urogenital fistulae comparing the etiology, management, and outcomes in a developed and underdeveloped countries.
Materials and methods
Fifty-three patients with urogenital fistulae were surgically repaired at two different countries. Twenty-nine of those were treated in Istanbul, Turkey during last 10 years period and the other 24 patients were operated in Maradi, Niger in August 2007. Detailed information on obstetric history and previous surgical procedures were questioned in all of the patients. Specific evaluation included instillation of dye in the bladder to locate the site of the fistula and intravenous urography were applied to patients with suspected urogenital fistula to confirm the fistula tract. The site, number and the size of fistula, as well as the pliability of tissues was assessed before the operation. The position of patients for surgery and the route of repair were individualized according to the appropriate access to the fistulae. Patients were reviewed 4–10 weeks after surgery to determine the end results of the operations.
Over all, obstetric complications (47%) were the most common cause of urogenital fistulae. Gynecologic surgeries were responsible for 41% of the cases. Although obstetric causes were prominent at patients in Niger, gynecological surgery was the main cause in Turkey. The most common type of fistulae was vesicovaginal. With regard to surgical approach to urogenital fistulae; the transabdominal approach was chosen in 12 (22.6%) of patients and transvaginal repair was performed in 41 (77.4%) of patients; 94.34% of the patients were completely dry after the first attempt.
A high percentage of patients with genital fistulae can be rendered dry and continent by assessment of these conditions; meticulous attention must be applied for the absence of inflammation and infection at the fistula site before the operation. Surgical team must be experienced at both abdominal and vaginal repair. Broad-spectrum antibiotics and continuous bladder drainage must be applied to all patients for at least 2 weeks. Interposition flaps must be used in complex cases.
KeywordsUrogenital fistula Vesicovaginal fistula
- 5.Holme A, Breen M, MacArthur C (2007) Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia. Br J Obstet Gynecol 114:1010–1017Google Scholar
- 6.Kelly J (1995) Ethiopia: an epidemiological study of vesicovaginal fistula in Addis Ababa. World Health Statistics Quarterly Rapport Trimestriel de Statistiques Sanitaries Mondiales 48:15–17Google Scholar
- 8.Dorairajan G, Reddi Rani P, Habeebullah S (2004) Urological injuries during hysterectomies: a six-year review. J Obstet Gynaecol 30(6):430–435Google Scholar
- 16.Browning A (2006) Risk factors for developing residual urinary incontinence after obstetric fistula repair. Br J Obstet Gynecol 113:482–485Google Scholar