Iatrogenic Female Genital Fistula, 35 Cases Report

Introduction: Female genital fistula (FGF), remains a world concern, especially in low developed country. Obstructive (blocked) delivery labor is his principal cause, sometimes by pelvic surgery (urogenital or obstetrical, rectal) more rarely by congenital urogenital malformation, excision, pelvic neoplasm, pelvic radiotherapy. We were interested in iatrogenic FGF treated in the special referral fistula center. Methodology: We report 35 cases of iatrogenic female genital fistula. Are included only cases by urogenital surgery, excision in the National Referal Center of Obstetrical Fistula. Were not included cases happened by over 12 hours blocked delivery labor, caustic destruction, pelvic cancer pelvic infection and those with incomplete file. The epidemiologic, clinical and therapeutic information were studied. All ethical protocols were respected. Results: CNRFO recorded 743 cases of female genital fistula from May 23 2013 to May 23 May 2018 within 35 iatrogenic cases (4.71%). Patients were 19 - 29 years old (42.85%), average age 35 years old, extremes 19 - 60 years, without occupation (82.86), grand multiparous 48.57%, with a mean of 4 previous deliveries. The principal constancies were hysterectomies 71.43%, caesarean section 17.14%, genital excision 11.42%, and cystocele cure 11.42%. The anatomical finds were soft vagina tissue 97.14% uretero-vaginal fistula 45.71% (2 cases post Caesarean, 14 cases post hysterectomy), vesico-vaginal 31.43% (all post hysterectomy), ureteral 11.42% (all post caesarean), 1 vesico-uterine 5.71% (case post caesarean), 1 case after a cystocele cure, 2 uretro-vaginal 11.42% secondary of genital excision. Treatment was ureteral reimplantation (18/31) cases by abdominal way, fistulorraphy (12/31) and 1uretroplasty by vaginal, 4 cases treated with transurethral bladder probe. 30 were cured by fistulas surgery, 1 urinary tress incontinency and 1 not closed, and 4 of transurethral bladder probe were cured. Conclusion: The female genital fistula is sometimes the consequence of Caesarean, hysterectomy, gynecological surgery, urologic surgery and some traditional practices.

Prognosis of 148 New Cases of Female Genital Fistula in a Multicentric Study in Niger

Introduction: We report anatomopathological and treatment results of new cases of obstetrical female genital fistula in main to determine the prognosis. Methodology: Multicentre prospective study over 15 months (January 1st, 2016 to March 31st, 2017) in 5 national centres of female genital fistula treatment. Patients were in all age group. Anatomopathological types were urogenital classified simple, middle and mixte (association of urogenital and recto genital). The methods of treatment were surgery and trans uretral vesical probe. We observed treated patients during 3 months. Results: 148 new cases collected. The study revealed 47.15% of urogenital fistulas were vesico-vaginal and urethro-vaginal (25.71%). 3 cases of rectovaginal fistula including 2 cases in the lower third of the rectum and one in the upper third, 141 patients were treated. The results gave 35 cases treated by trans ureterovesical probe cured and dry, those by surgery were continent and dry (71.62%) but 23 (15.54%) treated but not dry, 12 (4.10%) FGF were not closed tTab5) 7 cases not treated, one referred to urology service, one patient died before treatment and 5 perdu of view. Conclusion: Obstetric fistula remains a serious public health problem in Niger. FGF happened in all age old because of non skilled pre- and per-natal care particularly in rural area. Treatment could be improved but political prevention must be the rule.

Multicentric Study of 148 New Cases of Female Genital Fistula Niger

Introduction: Obstetric fistula is a public health problem but its prevalence remains unknown in Niger. We report epidemiological and anatomopathological status of new cases of female genital fistula. Method: Multicentre prospective study over 15 months (January 1st, 2016 to March 31st, 2017) in 5 national centers for the therapeutic management of female genital fistula. Data were collected from focus groups, observations and pre-established individual survey form and hospital records. Results: During the 15-month survey period, 148 new cases of female genital fistula of obstetric origin were recorded. Patients aged 15 to 19 accounted for 40% of cases. They were married before the age of 16 (55.4%), out of school in 89.2% and 77.2% lived outside the matrimonial home. The patients came from rural areas (96%) of the cases, the labor of delivery lasted more than 24 hours in 71.6% and in 95.3% of the cases the delivery was initiated at home and then finished in a health facility, 33.8% had assisted vaginal delivery (forceps/suction cup), 23% by caesarean section and 10.81% by laparotomy for uterine rupture. Fistula occurred during first delivery (47.3%) and recurrence accounted for 5.4% of cases. Perinatal death accounted for 85.1%. Conclusion: Female genital fistula of obstetric origin remains a major public health problem in Niger despite the efforts made.