Management of vesico-vaginal fistulas in women

Objective: Urinary fistulas resulting from obstetric trauma remains a major problem in developing countries. Surgical success rates, however, range from 61% to 95%. This study reviews the main causes of fistulas, and the surgical techniques and success rates of surgical closure. Method: A total of 1086 cases of urinary fistulas resulting from obstetric trauma over 25 years were reviewed. All women received surgical intervention. Various types of fistulas as well as specific surgical techniques are described, and patient age, parity, and probable cause of fistula. were compared with findings from studies in Africa. Results: The highest number of cases (47.6%) occurred in women aged between 26 and 35 years; moreover, 54.43% of the women were para 6 and higher. Obstructed labor contributed to 72.78%, cesarean hysterectomy to 7.60%, cesarean section to 7.30%, and other obstetrical traumatic procedures to 12.28% of the cases. Surgical success was achieved in 84.5% of the cases. The major residual problem of stress incontinence was noted in 5% of the cases. Conclusion: Besides prevention, the basic principles Of fistula repair are the most important factors in achieving surgical success. Better preoperative preparation and rigorous measures for preventing postoperative infection can help increase the success rate of fistula repair. (C) 2004 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.