Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital

Abstract

Aims: Vesico-vaginal fi stula (VVF) is an abnormal fi 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 profi le, their demography and outcome in the early phase of fi stula surgery performed in our institute.

Methods: This was a retrospective study of 222 patients who underwent fi stula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The fi stula were classifi ed according to Goh`s system. Patients’ demography, obstetric characteristics and fi 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 fi stula due to obstetrical cause, contributing 58% (n=127) and in 42 % (n=95) of patients had fi stula of gynecological etiology. Most of the patients had fi stula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh’s classifi cation. Among 127 fi stulas repaired of obstetric etiology100 (78.7%) patients and 85 (89.4%) out of 95 fi stula patients of gynecological cause were continent and dry.

Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric fi stula, however iatrogenic fi stula was also becoming common. Majority of our cases had successful outcome with some degree of stress in some patients.

Keywords: fi stula repair, iatrogenic fi stula, obstetric fi stula, vesicovaginal fi stula.