Profile and Outcome of Obstetric Fistula Surgeries in a Fistula Care Centre in South-East Nigeria

Abstract

Prolonged obstructed labour is the main cause of obstetric vesico-vaginal fistula, however there is growing perception that a proportion of cases may be arising from surgical complications and errors. This study intends to evaluate this observation. A retrospective study of 378 eligible cases of obstetric VVF repaired over a five-year period. Requisite information was retrieved from hospital case records. Dataentry and analysis was done using SPSS version 20. Means and SD, Chi square test and the level of significance set at p<0.05 were calculated. The mean age was 33.9±10.1 years, mostly multipara, majority following caesarean sections in 62.3% followed by prolonged obstructed labour in 28.6% of patients. The most common type of VVF was Intra-cervical fistula in 55.8% of patients. At the time of hospital discharge following repair, 76.5% were closed and dry, 18.5% had post-repair incontinence and 5.0% had a failed repair within the studied period. Half of our patients (50.3%) were referred from private hospitals, 40.3% had no referral letter and the remaining were referred from government hospitals. The outcomes of surgeries were not influenced by the type of VVF repaired. Chi square test was 0.38 at 95% CI (p>0.05). There is a worrisome proportion of obstetric VVF from caesarean sections. Our success rates in obstetric VVF repair appears satisfactory; more effort be made in strengthening the referral system and impacting correct surgical skills especially in areas of caesarean section.