Obstetric Fistula: Epidemiological, Social and Therapeutic Aspects: Prospective Study of 196 Patients Admitted to the ZINDER Mother and Child Health Centre (CSME)

Introduction: Obstetric fistula (OF) is an abnormal communication between the genital and urinary tracts and/or associated with a recto-vaginal communication resulting from prolonged dystocic delivery. It is a frequent pathology in underdeveloped countries. In Zinder no study has been carried out on obstetric fistula. The aim of this study was to evaluate the epidemiological, social impact and therapeutic aspects of obstetric fistula at the CSME of Zinder. Patient and Method: This was a descriptive cross-sectional study of obstetric fistula care at CSME during the period of (January 2018 to June 2020). Results: A total of 196 cases were collected over 30 months. This represents an annual incidence of 78.4 fistulas. The median age of the patients was 18.63 years, and more than 65% were over 20 years old. One hundred and ninety-one patients (97.45%) did not attend school, and 56.12% (n = 110) lived in polygamous households. One hundred and fifty-one women (n = 151), 77.04% had full assistance from their husband during the first four (4) months of the pathology. Twenty-four (12.24%) had been notified of repudiation. Obstetrical risk of dystocia was found in 39.79% (n = 78) of the patients, of whom 24.49% (n = 48) had a focused antenatal consultation (CPNR). The labour lasted more than 24 hours in 100%. The majority of women are multiparous and 60% had at least 2 pregnancies. vesicovaginal fistula is the main pathological type with 86.23%. Fistulas were closed in 83.16% and 68.87% exited without urine loss. Conclusion: Obstetric fistula is a devastating disease affecting girls and young women in Niger, as in other countries in Africa and Asia. It is a major concern worldwide and is a social tragedy because it is disabling and depressing.

Female Genital Fistula Deemed Incurable in a National Obstetric Fistula Reference Center in Niger

Introduction Female genital fistula remains a global concern especially in incoming countries. The majority of cases resulted from obstructed delivery labor. The treatment is by surgery exceptional by probe for very small cases. But some ones remain incurable after several surgery theaters. The objective of this study is to establish the epidemiology anatomopathological types and prognosis of FGF considered being incurable in our center. Methods This is a retrospective and prospective descriptive study from January 2, 2017 to July 14, 2021 on incurable cases of female genital fistula recorded at the Centre National de Réparation de Fistule Obstétricale (CNRFO) of Niamey for complex cases of fgf. The epidemiology, the lesions of vagina, uretra, bladder, the treatment and prognosis have been studied. Results A total of 522 cases were operated within 5 cases given incurable (0.95%). The 5 cases were 37 - 49 years old, they had fistula at their first delivery, the mean age of the fistula was around 9 years. The anatomopathological founds were vaginal severe sclerosis, extensive supra-trigonal fistula, total ureteral destruction, and partial bladder destruction. All the 5 patients treated by surgery were declared incurable. Conclusion Female genital fistula is not life-threatening but a major definitive handicap for theses prim parous. The treatment fail is linked with local lesions, continuous urine and fecal incontinency, added by iterative surgery. They remain judged incurable whether a surgery was by skilled practitioner.