Vesicovaginal Fistula: A Review of Nigerian Experience

Abstract

BACKGROUND: Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing countries. OBJECTIVE: To review the causes, complications, and outcome of vesicovaginal fistula in Nigeria. METHODS: Studies on vesicovaginal fistula were searched on the internet. Information was obtained on Pubmed (medline), WHO website, Bioline Innternational, African Journal on Line, Google scholar, Yahoo, Medscape and e Medicine. RESULTS: Many Nigerian women are living with vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria than southern Nigeria. Obstetric fistula accounts for 84.1%-100% of the vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9%-96.5%) in all the series. Other common causes include caesarean section, advanced cervical cancer, uterine rupture, and Gishiri cut. The identified predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria, while unskilled birth attendance and late presentation to the health facilities was common nationwide. Among the significant contributory factors to high rate of unskilled birth attendance were poverty, illiteracy, ignorance, restriction of women's movement, non-permission from husband, and transportation. All but one Nigerian studies revealed that primiparous women were the most vulnerable group. Pregnancy outcome was dismal in most cases related to delivery with still birth rate of 87%-91.7%. Stigmatization, divorce and social exclusion were common complications. Overall fistula repair success rate was between 75% and 92% in a few centres that offer such services. CONCLUSION: Vesicovaginal fistula is prevalent in Nigeria and obstetric factors are mostly implicated. It is a public health issue of concern.

Living with vesico-vaginal fistula: experiences of women awaiting repairs in Ebonyi State, Nigeria

“…This has helped in the understanding of the lived experiences of these women who had to devise means of coping with VVF. Our data regarding causes of VVF collaborated with what has been previously reported about women living with VVF (Mohamed et al, 2009;Ijaiya et al, 2010;Khisa & Nyamongo, 2012). Like findings from previous studies none of the ten women knew the actual cause of her condition rather they attributed it to supernatural causes.…”

“…Most of the studies on VVF in Nigeria have addressed the socio-cultural and health system factors that predispose women to the condition, the implications of VVF on livelihoods, the clinical management of the condition and barriers to health-seeking behaviours of VVF patients (Harrison, 1983;Ojanuga, 1994;Aboyeji, 1997;Muneer-Deen et al, 2002;Ijaiya et al, 2010). Poorly documented in the existing literature are VVF-afflicted women's direct accounts and experiences of living and coping with the condition.…”

Outcome of using a modified surgical technique for the repair of complex vesicovaginal fistulas in Nigeria

“…1,2 Nigeria's position as the most populous country in Africa carries with it the notoriety of having the largest number of vesicovaginal fistula patients in the world. With a prevalence of 400,000 to 800,000 women living with vesicovaginal fistula and an incidence of 20,000 new cases annually, the magnitude of the menace is not only huge but carries the potential of escalating over time.…”

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

“…Complications such as dysparunia, infertility, amenorrhea and gynaestresia also exist. 8,9 The need for a "cure" or repair is therefore important to preserve not just the integrity of the woman but reduce the morbidities and mortalities associated with this disease. GUF is continually described as a 'preventable disease' and much is being addressed to this effect.…”