Abstract
Objective To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years' period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. Results 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05–3.1]), low level of education (OR = 5.4; CI = [2.3–12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7–6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1–4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1–20.5]). Conclusion OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.
Highlights
Urogenital fistula (UGF) is an abnormal communication between the urinary and the genital tracts leading to involuntary loss of urine through the vagina. is society scourge mostly affects sub-Saharan Africa and South Asia regions with an incidence of 1.13 women in 1000 of childbearing age [1]. e social, economic, and psychological handicap caused by the UGF places them as a major public health problem [1,2,3,4]. e most common etiologies of UGF are obstetric (OF) and iatrogenic (IF)
We considered as iatrogenic all UGF that occurred after prophylactic caesarean section, gynecologic surgery, or induced abortion
Women repaired for UGF in the seven centers N = 497
Summary
Urogenital fistula (UGF) is an abnormal communication between the urinary and the genital tracts leading to involuntary loss of urine through the vagina. is society scourge mostly affects sub-Saharan Africa and South Asia regions with an incidence of 1.13 women in 1000 of childbearing age [1]. e social, economic, and psychological handicap caused by the UGF places them as a major public health problem [1,2,3,4]. e most common etiologies of UGF are obstetric (OF) and iatrogenic (IF). E most common etiologies of UGF are obstetric (OF) and iatrogenic (IF). OF represent 87% to 95.6% of all UGF in low-resource countries [2, 3, 6]. Both OF and IF lead to an uncomfortable loss of urines but have different physiopathological mechanisms. Are their sociodemographic, clinical, and therapeutic aspects so different? Ere are studies on each of these two etiological types of UGF in Africa, but accounting for available data, there is a lack of comparative Clinical, and therapeutic aspects so different? ere are studies on each of these two etiological types of UGF in Africa, but accounting for available data, there is a lack of comparative
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