Management of Iatrogenic Obstetric Fistulas in the Urology Department of CHU Point G, Apropos of 62 Cases

Abstract

Objective: Analyze the epidemiological, anatomo -clinical, therapeutic and evolutionary aspects of iatrogenic obstetric fistulas linked to a gynecological/obstetric procedure (caesarean section, hysterectomy, myomectomy, use of forceps, treatment of uterine prolapse, or vaginal surgery). Patients and Methods: This was a descriptive prospective study, concerning 62 patients hospitalized in the Urology department of the Point-G University Hospital from January 5, 2010 to June 30, 2014 for iatrogenic obstetric fistulas. The epidemiological, anatomo -clinical, therapeutic and evolutionary aspects were analyzed. Results: Iatrogenic obstetric fistulas were found in 19% of patients out of 321 cases of urogenital fistulas hospitalized in urology. The average age was 32 years with extremes of 15 and 52 years. The revealing clinical signs were: permanent loss of urine (87.10%), loss of urine while standing (9.70%), loss of urine while lying down (3.20%). Gynecological/obstetric procedures: caesarean section n= 39, hysterectomy n= 15, myomectomy n= 1, use of forceps n= 5, cure of uterine prolapse, vaginal surgery n= 1) were the most common causes. Type V fistulas were the most encountered with 74.20% and among these V fistulas, retro-trigonal fistulas were the most represented with 37.80% of cases followed by uretero-vaginal fistulas (31.10%) and vesico-uterine fistulas (15.60%). The upper route was used in 41 cases; followed by the low way in 18 cases and the mixed way in 3 cases. Trigono -cervico-uterine duplication was performed in 23 cases followed by uretero -vesical reimplantation in 19 cases. The treatment was satisfactory in 55 cases, i.e. 88.70% (no leakage) and poor in 7 cases.