Association Of Vesico-Vaginal Fistula to The Congenital Ureter Abnormality: About Two Cases in Two African Countries

Abstract

A significant number of preventable deaths occur during pregnancy and childbirth in developing countries where maternal mortality ranges from 500 to 1000 per 100,000 live births; for every woman who dies, an estimated 16 to 30 more survive with preventable complications. Obstetric fistula can be considered the most tragic complication during childbirth. WHO estimates that there are about 2 million cases of VVF worldwide and 50,000 to 100,000 new cases each year. [5, 6] The vast majority of cases are reported in sub-Saharan Africa and Southeast Asia where qualified obstetric assistance is random. Obstetric fistulas are thus a major public health problem in poor countries. Obstetric fistula is an abnormal communication between the urinary tract (the ureter, bladder and urethra) and/or digestive (rectum), on the other hand the genitals (the uterus and vagina) occurring during delivery. Various types of fistula are distinguished: uretero-vaginal fistulas, vesico-uterine fistulas and vesico-vaginal fistulas (VVFs). These take into account uretro- vaginal fistulas. RVF, associated or not with a VVF, is a communication between the rectum and the vagina. The most common are VVFs. Many etiologies are recognized in VVFs, but studies in Africa have shown that in the majority of cases, are of obstetric cause. Obstetric Fistula occurs as a result of obstructed labor characterized by prolonged delivery without the possibility of caesarean section. Uretero-vaginal fistula is characterized by the ectopic drainage of the ureter in the vagina causing a permanent flow of urine through the vagina. Although the congenital origin is rare, iatrogenic etiology remains common during a caesarean section or poorly performed hysterectomy. It results from a ligation or damage of the ureter at its crossing with the uterine artery. The ureter attached to the vaginal wall eventually drains urine into the vagina within a few hours or days of the procedure. Duplicity and uretero-pyelic bifidity are rare abnormal uropathies whose surgical discovery is the most common diagnostic method in developing countries where high-tech diagnostic method is not affordable. The rarity of the pathology and the non-systematic prescription of certain analysis (as IVU) for the preoperative assessment of urogenital fistulas justify the paucity of the literature on this subject.