Genitourinary Fistulae Experience in a University Teaching Hospital: A South-South Nigeria Perspective

Abstract

Background: Genitourinary fistula is a debilitating condition affecting women globally with high incidences in developing countries. It remains an indicator of the quality of health care delivery women are offered.Objective: To present the experiences of genitourinary fistulas (GUF) at the University of Port Harcourt Teaching Hospital (UPTH), Rivers State. Methods:From January 2002 to December 2012, 104 consecutive patients with genitourinary fistulas were admitted for evaluation, treatment (surgical) and thereafter followed up. Demographic and clinical data were collected. The patients were re-evaluated 3 months after surgery.Results: Among the 67 patients treated surgically, 75% were aged between 18 and 36 years; 46 (44.2%) had vaginal repairs while 21 (20.1%) had abdominal repairs. The fistulas were caused majorly by prolonged obstructed labour (72.4%) with only 6 non obstetric causes. 37 of these patients are yet to be repaired after an initial examination under anaesthesia that was performed for every patient. These admissions do not represent or reflect the incidence of genitourinary fistulas in this centre. These characteristics provide data towards the development of an obstetric fistula prevention program in Rivers State as one presently does not exist. Conclusion:There is an increasing incidence of GUF in this environment basically due to poor obstetric care despite different strategies proposed by different studies to the government to prevent and eradicate GUF. It also demonstrates the ability of repair or cure to restore the dignity of our women if proper training and retraining of residents and specialists, funding and making health care and facilities available to these women.

Genitourinary fistulas experience in a tertiary hospital in North-Western Nigeria

“…The finding of majority (69.2%) of the genitourinary fistulas in this study being of obstetric origin is in consonance with the finding in studies conducted in Nigeria [17][18][19] and other sub-Saharan African countries 12,21,22 and it exposes the failure of the health systems in the countries across the continent to deliver accessible, timely and appropriate intrapartum care to pregnant women.…”

“…This is quite low and may not contribute significantly in clearing the backlog of patients living with fistula in the area. Similar to the finding in this study, only a few patients were also treated at the teaching hospitals across Nigeria, including University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, 17 where only 67 patients were managed for genital tract fistula over a 10-year period; Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, 18 where only 55 patients were managed over a 10-year period; and University of Ilorin Teaching Hospital, Ilorin, Nigeria, 19 where only 34 patients were managed over a 10-year period. The low patient turnout for management of fistula in this study and in studies conducted in the other teaching hospitals in Nigeria could be due to the high cost of admission and surgery in the tertiary hospitals in the country, thus making their services financially inaccessible to the fistula patients who are mostly poor.…”

“…It is therefore not surprising that almost all the patients in this study had no formal education (94.2%), and were full-time house-wives (98.1%). Studies conducted in other hospitals in Nigeria, 11,17,19,20 and other sub-Saharan African countries including Zambia, 21 Ethiopia, 22 and Uganda, 23 majorly reported similarly young population of obstetric fistula patients, with little or no formal education and unemployed. A meta-analysis of national household surveys that included data for 262,100 women of reproductive age (15-49 years) in 19 sub-Saharan African countries reported a very high prevalence of symptoms of vaginal fistula, with a lifetime prevalence of 3.0 cases (95% Confidence Interval [CI]: 1.3-5.5) per 1000 women.…”

Social Features and Morbidity Patterns of Women with Obstetric Fistulae at an Obstetric Fistula Centre in a University Teaching Hospital in Jos, Nigeria

“…Studies done in Kano [45], Jos [46] and Port Harcourt [47] have shown the relevance of marriage and ethnicity in the occurrence of Obstetric fistula. In this study, half of the respondents were married in a monogamous setting before fistula developed, a third married in a polygamous setting and just a few of the patients were single.…”

“…This in contrast to finding done in western Uganda 10 where 77.9% had successful closure of their fistula. This difference could be due to patient factors like size of fistula, comorbidities; surgeons' factors like skill, surgical technique, facilities, postoperative management and other variables which are difficult to compare [47]. Overall success rates of vesicovaginal fistula repair were 75% 91.5%, 92%, and 87.9% in Port Harcourt [47], Ile-Ife [51], Jos [46] and Ilorin [52], respectively.…”