Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study

Abstract

Objective. To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years’ period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. Results. 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05–3.1]), low level of education (OR = 5.4; CI = [2.3–12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7–6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1–4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1–20.5]). Conclusion. OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.

The teenage pregnancy on obstetric fistula among women in fistula center at Malalai Hospital, Kabul Afghanistan: A cross-sectional study

“…In our study at the fistula center of Malalai Hospital 46.7% of women had 1-4 parity with a mean of 5.2±3.13 and extreme of (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Holme reported 49.0% of patients were primiparous, and 27.6% were parity four [15] .…”

“…Kpatcha et al reported the middle age of patients 40.7 y, with extremes (18 -70 y) [12] . M., Ouattara, A., Kirakoya D. reported the mean age of the patients at the time of diagnosis was, respectively, 37.8 ± 12.2 (min 19, max 70y) [13,14] . Among older women and the grand multipara, the reason for developing obstetric fistula could be prolonged labor due to abnormal presentation and fetal position with possible injury to the bladder and uterus but at a young age at first, delivery are predisposing factors to the development of fistula due to the undeveloped pelvis and obstructed labor [3,4] .…”

“…This was based on 2 fistulae found in the rural region elsewhere they refer to these regions as small towns [3,22] . In the study by Ouattara revealed the majority of patients (58%) of obstetric fistula were from rural areas [13,14] . Melah revealed that rural place of residence (95%) were also factors associated with acquiring the fistulae 16 it is similar to Saqib, study which demonstrated most of obstetric fistula cases (95%) were in rural areas [23] .…”

Epidemiologic and Therapeutic Aspect of Urogenital Fistula Following Obstetric and Gynecologic Surgeries Repaired at the Nkwen Baptist Hospital

“…The mean duration from onset of UGF to fistula repair was 5.36 (SD 7.7) years. Tebeu et al in Cameroon 2019 had a similar result [15] where the average duration of fistula progression was 5 years. This can be explained by the fact that few fistula surgeons are available in our setting.…”

“…In the industrialized world, the most common cause of urogenital fistula is injury to the bladder at the time of gynaecologic, urologic, or other pelvic surgery [13]. Most of the studies in our setting focused on obstetric fistulas [12] [14] [15] however, specialists of the field perceived a change of trend in developing countries, revealing an increasing proportion of iatrogenic fistula [4]. In 2014, a study conducted in Yaoundé Cameroon showed that the prevalence of non-obstetric genitourinary fistula represented 19.78% of urogenital fistula post surgeries accounting for 72.20% while non-obstetrical genito-digestive fistula represented 27.80% [10].…”