Vesicocutaneous Fistula: A Rare Complication of Pelvic Trauma

Background: Vesicocutaneous fistula is a rare type of urinary fistula. It is often distressing and may negatively impact on the quality of life of an affected person. Our aim in this case report is to document a case of vesicocutaneous fistula following pelvic trauma from road traffic accident and share our experience in the management of this condition. Case Report: We report the case of a 30 year-old primipara who had urinary incontinence following pelvic trauma sustained from road traffic accident. Examination findings were in keeping with vesicocutaneous fistula. She subsequently had surgical repair of vesicocutaneous fistula which was successful. Conclusion: This case report highlights pelvic trauma as one of the causes of urinary fistula and the key role of surgery in its management.

Non-Fistulous Complications of Prolonged Obstructed Labour among Obstetric Fistula Patients in Southern Nigeria

Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women. These included cervical retraction (42.2%), obstetric nerve palsy (30.4%), vaginal scarring (29.8%), partial urethral loss (16.1%), anal sphincter injury (3.1%), cervical stenosis (5.0%) and urethral stenosis (3.7%). Others were ammoniacal dermatitis (29.2%), secondary amenorrhoea (21.7%), secondary infertility (9.3%), dyspareunia (6.8%), hypomenorrhea (1.2%) and bladder stone (3.7%). Majority (79.4%) of the women with cervical retraction had caesarean section (CS) as against 20.6% who had vaginal delivery. This was statistically significant (P 0.001). A higher proportion of participants with amenorrhea were delivered via CS (44.3%) compared to those who had vaginal delivery (21.2%). This was also statistically significant (P = 0.012). Neurologic injury was associated with primiparity although this was not statistically significant (P = 0.171). Conclusion: Almost all fistula patients also have non-fistulous complications of prolonged obstructed labour. Efforts to manage the fistula should equally address these complications. We advocate comprehensive care for identification and management of these injuries to improve the quality of life and overall well-being of these women. To reduce complications like cervical retraction, there should be an emphasis on safer caesarean section for women with prolonged obstructed labour.

Endocervical Swab Microbial Isolates among Women with Third Degree Uterovaginal Prolapse

Background: Uterovaginal prolapse is the descent of the uterus through the vaginal canal. This may be a predisposing factor to infections in the urogenital system. This study aimed to assess the endocervical swab microscopy, culture and sensitivity in patients with third degree uterovaginal prolapse at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria. Methodology: This is a cross-sectional prospective study to assess the endocervical swab microbial findings in patients with third degree uterovaginal prolapse using simple random sampling technique. Data on sociodemographic variables, risk factors for pelvic organ prolapse, and endocervical swab findings among women with third degree uterovaginal prolapse were collated and analysed using statistical methods. Results: The mean age and parity were 50.5 years ± 9.1 and 6.7 ± 2.0 respectively. Thirty-six (85.7%) of the clients were grandmultipara and 37 (88.1%) were farmers. Pus cells were present in all samples while 27 (64.3%) had microbial isolates. Streptococcus pyogenes was isolated in 7 (16.7%), Streptococcus faecalis in 5 (11.9%), Escherichia coli in 5 (11.9), Staphylococcus aureus in 4 (9.5%), Klebsiella pneumoniae in 2 (4.8%) and Yeast cells in 4 (9.5%) of the endocervical swabs. All isolates were sensitive to gentamicin. Bacterial isolates were resistant to amoxicillin/clavulanic acid. Conclusion: This study showed growth of pathogenic organisms from the endocervix of women with third degree uterovaginal prolapse. A 100% sensitivity to gentamicin was observed in the study.

Enterovesical Fistula Complicating Myomectomy: A Case Report

Background: Enterovesical fistula is an abnormal communication between the bladder and the gastrointestinal tract. It is an uncommon type of genital fistula, occasionally complicating pelvic surgeries. However, it is the most common type of fistula associated with diverticular disease of the colon. Other causes include cancer, trauma and iatrogenic injuries. Pneumaturia and fecaluria usually implies enterovesical fistula. Enterovesical fistula complicating myomectomy is an uncommon finding. Our aim is to report a case of enterovesical fistula following myomectomy. Case presentation: She is a 33-year-old nullipara who presented at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State, South-Eastern Nigeria with a history of fecaluria, pneumaturia and haematochezia which started after myomectomy. Feculent fluid was obtained on urethral catheterization. Cystography was suggestive of enterovesical fistula. Conclusion: Enterovesical fistula is a possible complication of myomectomy. A high index of suspicion for this rare but potentially devastating condition is important for early diagnosis and appropriate management.

Prostate Specific Antigen Screening among Men in Abakaliki, South East Nigeria

Background: Prostate cancer is the most common type of cancer among Nigerian men. Prostate specific antigen (PSA) is produced by the prostate gland and it is an important tumor marker in the screening and diagnosis of prostate cancer because the latter is often associated with elevated PSA levels. The aim of this study was to evaluate the profile and PSA levels of men presenting for prostate cancer screening at the National Obstetric Fistula Centre, Abakaliki, Nigeria. Methods: This was a retrospective study of 103 patients who were seen between January 2014 and December 2015 and screened for prostate cancer using PSA assay. Data was extracted from folders of patients using a proforma and analysed using the Statistical Package for Social Sciences (SPSS), version 21. Result: Out of the 103 clients studied, 67 (65%) were between the ages of 40 and 59 years. The mean age was 54.38 ± 12.5 years. Eighty-one (78.6%) of the study population had PSA levels 4 ng/ml and below, 5 (4.9%) had PSA levels of 4.1 - 10 ng/ml, while 17 (16.5%) had PSA levels > 10 ng/ml. The mean PSA was 4.75 ± 8.2 ng/ml. None of the patients with family history of cancer had PSA levels of >4 ng/ml. Those who were positive for HIV also had normal PSA results. Conclusion: The findings from this study showed that the prevalence of men with raised PSA (>4 ng/ml) was high (21.4%) especially in the 60 - 69 years age group. There is need to increase prostate cancer screening using PSA in our setting. The use of other parameters such as digital rectal examination, PSA density, PSA velocity and free PSA will be helpful to determine the need for histological diagnosis in these patients.