Obstetric vesicovaginal fistulas: management and results of surgical treatment at the Labé Regional Hospital

Abstract

Introduction: The objective was to study the management and to analyse the results of surgical treatment of obstetric vesicovaginal fistulas (OVVF).

Material and methods: This was a retrospective, descriptive study lasting five years from 2016 to 2020.

Results: We collected 250 files of operated OVVF, representing 86.2% of operated obstetric fistulas. The mean age of patients was 38.2 years, the mean age at marriage was 14.2 years. The patients resided in rural areas in 95.2% of cases, were housewives in 99.2% of cases, not educated in 97.2% of cases, and who had not performed any prenatals consultations in 56%. The fistula occurred during the first delivery in 52% of patients. The average duration of labour was 3.32 days. Vaginal delivery in 64% of cases, and resulted in stillbirth in 91.2% of cases. The fistula had an average duration of evolution of 13 years. Group II OVVF (complex) were the most frequent (51.6%) and the vaginal route was the surgical approach in 93.6% of cases. The average duration of bladder drainage was 15.67 days. We found 71.2% of closed fistulas with continence, 14.8% of closed fistulas with incontinence and 14% of non-closed fistulas. This success rate varied considerably depending on the severity of the fistulas, i.e. 96.77% for group I fistulas; 83.72% for group II and 44.44% for group III.

Conclusion: OVVF is the most common obstetric fistula. Complex fistulas are the most encountered, the treatment is surgical and more than a third of patients are treated successfully, but this rate varies depending on the severity of the fistulas. Since all OVVF cannot be closed, it would be necessary to consider urinary derivation in these patients and to act on the preventive aspect.