Iatrogenic Urogenital Fistulas: Causes and Management in a West African City

Background: The management of obstetric fistulas is part of the daily life of the urologist in sub-Saharan Africa. More and more urogenital fistulas caused by health personnel are encountered. What about her iatrogenic urogenital fistulas in Lomé? What are the causes?

Methods: This was a retrospective study over 10 years, concerning cases of iatrogenic urogenital fistula treated at the teaching hospital Sylvanus Olympio in Lomé. The inclusion criteria were: all well-completed records of IUGF operated in urology. The variables studied were: age, the circumstances of occurrence of the IUGF, the type of operator, the delay in diagnosis, data on the fistula, the treatment of the iatrogenic fistula, the postoperative course, and the correlation between these parameters.

Results: From 2011 to 2020, i.e. 10 years, 43 cases of IUGF had been diagnosed and treated, i.e. a hospital frequency of 4.3 cases/year. The average age of the patients was 39.8 +/- 11.4 years with extremes of 25 to 85 years. Most of the patients were married with a rate of 95.4%; many patients had at most 2 living children, i.e., 46.5%. Among these surgical history, caesarean section was the most represented in 58.1% of cases. VVF was the most represented type of fistula, 81.3%. Most of the fistulas (in 27 patients or 62.7%) had appeared following surgical interventions performed by surgeons and obstetrician-gynecologists in training; there was a statistically significant link (p=0.002). The average time between the intervention that caused the fistula, and the repair surgery was 114.98 +/- 28.53 days. The approach was suprapubic in 74.4% of cases. The IUGF identified in our series had been treated either by fistulorraphy via the upper approach or via the vaginal approach. Caesarean section was associated with 21 cases of VVF. There was a statistically significant link (p= 0.0024).

Conclusion: The main point made during this work was that caesarean section and hysterectomy were the main causes of IUGF. VVF were more frequent, and surgeons in training were often incriminated.

Keywords: Iatrogenic Urogenital Fistula, Vesicovaginal Fistula, Etiologies, Reconstructive Surgery, West African City.