Abstract
Objective: To present the outcomes of patients treated at a tertiary center for a diagnosis of genitourinary fistula secondary to gynecological and obstetric etiologies.Study Design: In this retrospective study, analysis was made of 18 patients with a diagnosis of genitourinary fistula in a tertiary center between January 2006 and June 2016. Patient data were taken from the archives and patient histories. A record was made of examinations, diagnostic methods such as cystoscopy and fistulography and appropriate medical treatments, demographic data, intraoperative and post-operative complications, duration of hospital stay, surgical operations and types, diameter and location of fistulas.Results: Of the 18 cases, 14 were secondary to obstetric trauma. In 10 of these 14 cases, fistula had developed after difficult vaginal delivery and in four cases, after caesarean section. Four of the 18 cases were secondary to gynecological surgeries, namely hysterectomy and cystocele repairs. Vesicovaginal fistulas were repaired transvaginally while vesicouterine fistulas and bilateral ureterovaginal fistulas were repaired transabdominally. The mean hospital stay was 3.8±1.5 days (2-7 days). Patients were followed up closely in the first 3 months and recurrence developed in only one case.Conclusion: Fistulas secondary to gynecological procedures are uncommon while fistulas secondary to inadequate perineal care, insufficient labor monitoring and difficulties in vaginal delivery techniques are more prevalent in Turkey. Thorough evaluation, using all diagnostic tools for complete diagnosis, understanding the pathophysiology and choosing the best surgical procedure are mandatory to obtain good outcomes after the surgical
Highlights
Fistula is an epithelized, extra-anatomic tract between organs and/or body surface
Fistulas secondary to gynecological procedures are uncommon while fistulas secondary to inadequate perineal care, insufficient labor monitoring and difficulties in vaginal delivery techniques are more prevalent in Turkey
Vesicovaginal fistulas (VVF) were detected in 15 cases, of which 10 had a history of difficult vaginal deliveries and two cases had a history of cesarean hysterectomy due to uterine atony
Summary
Extra-anatomic tract between organs and/or body surface. These tracts between genital organs and the urinary tract are called genitourinary fistulas [1]. Genitourinary fistulas result in continuous or intermittent urinary incontinence. This is a significant public health issue. Quick Response Code: Access this article online Website: www.gorm.com.tr. Genitourinary fistula (GUF) is more prevalent in countries with limited access to healthcare. The underlying factors have been reported as obstetric trauma, prolonged labor and female circumcision in some African countries [4]. The precipitating factors are pelvic surgery, sling operations (transobturator tape-TOT, transvaginal tape-TVT, and mini sling), cancer surgery and history of radiotherapy [5,6,7]
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