[Current profile of obstetrical vesicovaginal fistulas at the maternity unit of the University of Casablanca]

[Epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas in Senegal]

AIM

To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal.

PATIENTS AND METHOD

This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure.

RESULTS

Forty-five (45) VVFs were identified over a period of 6 years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13 years with extremes of 13 years and 75 years; 17 patients (37.8%) were older than 45 years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32 years) (P = 0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF.

CONCLUSION

There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF.

LEVEL OF EVIDENCE

Level 4: retrospective study.

[Obstetrical vesico-vaginal fistula in Guinea: Data analysis of three sites of treatment at Engender Health ONG]

OBJECTIVE

To analyze the management of obstetric vesico-vaginal fistula in the three sites of Engender Health in Guinea.

PATIENTS AND METHODS

It was a retrospective study of descriptive type having helped collect 450 cases of vesico-vaginal fistulas in three support sites engender health between January 2008 and December 2011. The variables studied were epidemiological, clinical and therapeutic reasons and treatment outcomes were evaluated after a decline of at least six months.

RESULTS

The mean age of onset of the fistula was 25years, ranging from 12 to 55years and 58.8% (n=265) of patients were aged between 18 and 30years. The mean duration of fistula was 11years, ranging from 1 to 38years. Eighty-two percent (n=416) of patients were housewives and 66.4% (n=299) off school. The complex fistula with 66% (n=297) was the most frequent. The treatment consisted of a fistulorraphie after splitting vesico-vaginal in 93.3% (n=420) of cases. Therapeutic results considered after a mean of 8months have resulted in a cure in 79.3% (n=357) of cases, improvement in 4.2% (n=19) of cases and failure in 16 4% (n=74) of cases.

CONCLUSION

Vesico-vaginal fistula is a major cause of maternal morbidity in Guinea. The establishment of a real health policy based on sound medical and social structures contributes to its eradication.

LEVEL OF EVIDENCE

5.

[Evolution aspect of anatomy clinical lesions of urogenital fistula (UGF) in Cocody Teaching Hospital urological unity from 1990 to 2011]

PURPOSE

The aim of this study is to compare anatomy pathological lesions seeing in urogenital fistula in Cocody Teaching Hospital between two decades, 1990 to 2000 and 2000 to 2010.

MATERIEL AND METHOD

This survey is retrospective and carries on 20 years (January 1990 to December 2011) 190 urogenital fistulas (140 cases between 1990 and 1999; 50 from 2000 to 2011) hospitalized in our unity. Anatomy clinical characteristics of these fistulas were determined by clinical or paraclinical examination.

RESULTS

Between 1990 and 1999, fistulas were classified in 20 bladder-uterine fistulas (14.29%), 16 uretro-vaginal fistulas (11.43%) and 104 bladder-vaginal fistulas (74.29%) of whom 80 isolated UGFs and 24 UGFs associated with recto-vaginal fistula. These 104 UGFs were located at: bladder neck 22 cases (21.15%), bladder trigonal 46 cases (44.23%), urethra 14 cases (13.46%). Twenty-two bladder sphincter were destroyed and represented 21.15% of fistula's bladder-vaginal fistula and 15.71% of all UGFs. The average fistula diameter was 3 cm [extremes: 1 and 12 cm]. In 22 cases (15.71%), fistula diameter was more than 10 cm. It was bladder neck and sphincter destruction. Hundred and twenty-six fistulas were isolated (90%). Only 10% (14 cases) were associated. Fistulas were primitive in 85.71% of cases (120/140), recurrent in 7 cases (7.86%) and multi-recurrent (>3 reinterventions) in 9 cases (6.43%). From 2001 to 2011, no bladder-uterine fistulas were seen, but: 6 (13.95%) isolated uretero-vaginal fistulas and 6 (13.95%) uretero-vaginal fistulas associated with bladder-vaginal fistula, 31 (62%) bladder-vaginal fistulas of whom 20 (64.52%) bladder trigonal fistulas, 6 (19.34%) retro-trigonal fistulas and 2 (6.45%) urethral fistulas. Only three (9,68%) recto-vaginal fistulas were associated. The average fistula diameter was 2 cm. The fistulas were isolated in 40 cases (80%) and associated (VVF+uretero vaginal F) in 10 cases (20%). Thirty-five cases (70%) were primitive and 10 cases (20%) recurrent of whom 5 (10%) many recurrent. Fistulas were classified in simple fistula in 7 cases (14%) and complex fistula in 43 cases (86%)

CONCLUSION

UGF remained relatively frequent in Cocody Teaching Hospital, but the lesions have favorably evolved in the last decade. Simple type of fistula became more frequent than complex ones.

LEVEL OF EVIDENCE

4.

Risk factors for obstetric fistula: a clinical review

Obstetric fistula is the presence of a hole between a woman's genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. We conducted a search of the literature to identify all relevant articles published during the period from 1987-2008. Among the 19 selected studies, 15 were reports from sub-Saharan Africa and 4 from the Middle East. Among the reported fistula cases, 79.4% to 100% were obstetrical while the remaining cases were from other causes. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of cases, and combined vesicovaginal and rectovaginal fistulae were reported in 1% to 23% of cases. Teenagers accounted for 8.9% to 86% of the obstetrical fistulae patients at the time of treatment. Thirty-one to 67% of these women were primiparas. Among the obstetric fistula patients, 57.6% to 94.8% of women labor at home and are secondarily transferred to health facilities. Nine to 84% percent of these women delivered at home. Many of the fistula patients were shorter than 150 cm tall (40-79.4%). The mean duration of labor among the fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of patients labored for more than 24 h. Operative delivery was eventually performed in 11% to 60% of cases. Obstetric fistula was associated with several risk factors, and they appear to be preventable. This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level.

Risk factors for obstetric fistula in the Far North Province of Cameroon

OBJECTIVE

To describe the circumstances of occurrence and identify potential risk factors for obstetric fistula in northern Cameroon.

METHODS

A case series study of 42 obstetric fistula patients seeking services at the Provincial Hospital of Maroua, Cameroon, between May 2005 and August 2007. Structured interviews were conducted prior to surgical intervention.

RESULTS

Among obstetric fistula patients, 60% had lived with obstetric fistula for more than 5 years at the time of surgery. Eighty-one percent of patients had received no formal education and 86% were teenagers at their first delivery. Regarding the pregnancy and delivery preceding the occurrence of the fistula, 50% of women reported that they had received no prenatal care and 76% were in labor for more than 12 hours. The majority (83%) of women delivered a stillborn baby.

CONCLUSIONS

Obstetric fistula patients in the Far North Province of Cameroon had a low level of education, were married at a young age, and had poor access to quality maternal healthcare services.