TITLE:
Iatrogenic Female Genital Fistula, 35 Cases Report
AUTHORS:
N. Idi, I. Abdoulaye, F. Chaibou Nomao, Z. Assoumane
KEYWORDS:
Female Genital Fistula, Iatrogenic Fistula, Excision, Pelvic Surgery, Caesarian, Hysterectomy
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.9,
September
3,
2020
ABSTRACT: 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.