Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital

Abstract

Aims: Vesico-vaginal Þ stula (VVF) is an abnormal Þ stulous communication between the bladder and/or urethra and the vagina that allows continuous involuntary discharge of urine into the vaginal vault affecting patients' medical, physical, mental, social and sexual life. The aim of this study was to review and deliver a proÞ le, their demography and outcome in the early phase of Þ stula surgery performed in our institute.Methods: This was a retrospective study of 222 patients who underwent Þ stula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The Þ stula were classiÞ ed according to Goh`s system. Patients' demography, obstetric characteristics and Þ stula repair outcomes were reviewed. The primary outcome was in terms of urinary continence.Results: A total of 222 women aged between 10 to 65 years with a mean age of 31.4 were included. Majority of the patients had Þ stula due to obstetrical cause, contributing 58% (n=127) and in 42 % (n=95) of patients had Þ stula of gynecological etiology. Most of the patients had Þ stula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh's classiÞ cation. Among 127 Þ stulas repaired of obstetric etiology100 (78.7%) patients and 85 (89.4%) out of 95 Þ stula patients of gynecological cause were continent and dry.Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric Þ stula, however iatrogenic Þ stula was also becoming common. Majority of our cases had successful outcome with some degree of stress in some patients.

Vesicovaginal Fistula Post Caesarean Hysterectomy

“…Surgical approach is the most commonly preferred for affected women and the success rate varies between 75%-95% in literature. 2 The success rate has been associated with the etiology of the fistula, site of the fistula, size of the fistula and number of previous failed attempts at repair. 4…”

“…The patients were admitted and evaluated through detailed history, physical examination, relevant investigations and evaluation under general anaesthesia (EUA Fistulas are a recurring problem in areas where women have inadequate access to quality emergency obstetric care in developing countries, affecting patient's medical, physical, mental, social and sexual life. 2 It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. Iatrogenic postoperative VVF is the most common in developed countries, compared to mainly obstetric trauma in developing countries.…”