Urogenital fistula (UGF) is an abnormally acquired communication between the urinary and genital tracts [1] . Its incidence is declining in developed countries thanks to advances in surgery and obstetrics [2] , where iatrogenic lesions are the main etiology [3] . In Africa, it remains a public health problem [4] , with obstetric causes the main etiology [5] . FUGs have medical, economic and psychosocial repercussions. Advances in surgery and obstetrics have reduced the incidence of urogenital fistulas in developed countries [2] . FUGs due to obstetric causes are generally complex, associated with cervical or urethral destruction compromising the sphincter apparatus and requiring specific surgical techniques [2] . The treatment of urogenital fistulas is a problem that has confronted urologists since the 19th century [2] . Surgical treatment via transvesical, retroperitoneal and transperitoneal routes remains the most indicated method for vesico-uterine, trigono-vaginal and uretero-vaginal fistulas, with high success rates [6] .

The choice of treatment route depends primarily on the characteristics of the fistula and partly on the operator’s experience [6] . The aim of this work is to report on the results of surgical treatment of fistulas by the upper route, while describing the epidemiological and etiological characteristics of urogenital fistulas at the National Fistula Treatment Center.

This was a retrospective, descriptive and analytical study carried out at the National Fistula Treatment Center over the period from May 2011 to April 2021. All women with urogenital fistulas who had undergone fistula repair surgery via the upper approach and whose medical records were complete were included in the study. Women with non-urogenital fistulas, who were treated at another health facility and/or had incomplete medical records were excluded from the study. Data were collected from patient records, operating room registers, the CNTF database and pre-established survey forms to collect all the information relevant to this study. These survey forms noted the variables studied, which were of a socio-demographic and clinical nature: In this study, we used the DE M CAMEY classification system, which is based on the following criteria: reason for consultation, circumstances of occurrence, etiologies of the fistula, history, duration of fistula, type of FUG, lesions associated with FUG, method of diagnosis and outcome. For this study, we used the DE M. CAMEY classification. Our results will be classified as good (when micturition was normal with no urine leakage), intermediate (when stress incontinence or nocturnal urine leakage persisted) and failure (when urine leakage was permanent). Data were analyzed using SPSS 18.0 software. The Chi² statistical test was used to compare the relationship between variables, with a significance level of p < 0.05. For ethical and deontological considerations, we obtained research authorization.

During the study period, 2369 patients were treated for urogenital fistulas, including 84 by the upper route, representing a hospital frequency of 3.5%. The mean age was 28.5 ± 8.13 years, with extremes of 10 and 60 years. The most common age group was 21 - 30. (Table 1)

Obstetric aetiology was most frequently reported at 92.9%. This result is close to that of Kpatcha [7] in Togo in 2020, which found 95%, and higher than that of Fasnewindé A [8] in Burkina Faso in 2020, which found 81.7%. This high percentage is a reliable indicator of the inadequacies of our country’s health system, inadequacies characteristic of our underdeveloped countries. This figure also

Ureterovaginal fistula (UVF); Vesico-vaginal fistula (VVF); Utero-vaginal fistula (UVF).

indicates that the efforts made in recent years by our countries to reduce perinatal morbidity are insufficient.

In this series, 45.2% of patients underwent surgery once. This result is higher than that of Lamine N [9] in Guinea Biseau in 2016, who found 27.9%. This can be explained by the fact that in this series of studies, our patients were operated on several times, i.e. at least once before coming to the specialist centre. These multiple cures were sufficient proof of the complexity of fistula surgery, which must take into account the location of the fistula, the quality of the tissue, the size and experience of the repairer.

In terms of classification, type III fistulas dominate with a rate of 70.2%. This result is higher than those obtained by Vadandi [10] in Chad in 2019 and Kimassoum [11] in Chad in 2016, which obtained 54% and 40.5% respectively. This difference can be explained by the size of the sample and the long duration of the year (10 years).

Regarding the types of fistula, ureterovaginal fistulas are the most common anatomo-clinical aspect with a rate of 36.9%. This rate is higher than those of Sanda G [6] in Niger in 2016 and Konan P [12] in Côte d’Ivoire in 2015, who found a rate of 22.5% and 11.43% respectively. This difference could be explained by the fact that the study focused solely on upper urogenital fistulas, unlike some authors who have conducted their studies on urogenital fistula globally, where certain anatomo-clinical types predominate over ureterovaginal fistulas.

Locally, the tissue surrounding the fistula, in particular the vagina and perineum, were soft in 54.8% of cases. This rate is lower than that found by Sanda G [6] in Niger in 2016 who reported 75% soft tissue. The predominance of soft tissue could be explained by the fact that the vast majority of our patients had never benefited from a previous cure, as failure deteriorates the local tissue and leads to fibrosis.

As far as anaesthesia is concerned, spinal anaesthesia is the most commonly used type of anaesthesia, with a proportion of 85.7%. This result is superimposed on the data in the literature [6] [13] which reports 85.2% to 87%. Apart from contraindications, locoregional anaesthesia is the preferred technique because it involves fewer risks for patients.

Therapeutically, uretero-vesical re-implantation was the most common technique used in 39.3% of cases. This rate is lower than that of Fofana A [14] in Côte d’Ivoire in 2021, which found 64.7%, but higher than that of Sanda G [6] in Niger in 2016, which found 9.6%. This can be explained by the fact that in our series, ureterovaginal fistula, which is the anatomo-clinical type most represented in our series, is repaired by ureterovesical reimplantation using the upper route.

The duration of urethrovesical catheter use was 15 days in 40 patients (47.6%). This result is in line with the literature [5] [10] .

Regarding the duration of hospitalization, 75% had a hospital stay of 16 days. Komanda L [15] in the DRC in 2014 reported a hospital stay of between 14 and 19 days.

Regarding the outcome, the success rate of late surgery in this series was 85.7%. This result is within the range of those reported by Kpatcha [7] and Diallo A [16] , which were 78.17% and 91.8%. This could be explained on the one hand by the high or mixed approach which allows good exposure of the fistula and also good closure of the fistula, and on the other hand by the selection of fistulas which are high up, far from the continence system.

Urogenital fistulas are a real public health problem in our countries. Women who suffer from it are subject to all forms of social exclusion. Repairing the fistula allows these women to regain their dignity. The only way to combat this scourge is through prevention through information, education and communication.

The authors declare that they have no conflict of interest.

Mahamat, M.A., Valentin, V., Haroun, A., Nedjim, S., Gadam, A.A. and Rimtebaye, K. (2024) Upper Tract Treatment of Urogenital Fistulas at the National Fistula Treatment Center (CNTF). Open Journal of Urology, 14, 11-19. https://doi.org/10.4236/oju.2024.141002