Experience of Female Urogenital Fistula – a Shift of Dominance From Obstetric Variety to Iatrogenic One

Aim: This retrospective study was carried out in Jessore Medical College Hospital and Jhenidah District Hospital on different types of female urogenital fistulae to evaluate its aetiological aspect in the present health care scenario of the country. Materials and Methods: Female patients presenting with features of urogenital fistula were evaluated properly and operated through intra-abdominal and vaginal route depending upon the merit of the fistula. Aetiological pattern of the cases was evaluated along with surgical outcome and post-operative complications. Result: Ofthe 28 female urogenital fistulas, 27 (96.43%) were VVF and 1(3.57%) was UVF. Out of 28 cases, 71.42 %( 20patients) were post-hysterectomy complication, 21.42 %( 6 patients) cases resulted from birth trauma and 7.14 %(n=2) cases were post caesarean complication. Trans-abdominal route was used for operation in 22 (78.56%) cases while 6 (21.42%) cases were operated through trans-vaginal route. In this series of 28 cases, 89.29 %( 25 cases) patients were fully cured and10.71 %( 3cases) patients experienced recurrence. Conclusion: The aetiological pattern of the female urogenital fistula in our country has changed substantially from the dominance of birth trauma to post hysterectomy indicating a remarkable improvement in maternal care system along with development of other socioeconomic parameters. Bangladesh J. Urol. 2018; 21(2): 71-75 1. Assistant Professor, Department of Urology, Jessore Medical College, Jessore, Bangladesh. Correspondences: Islam MS, Assistant Professor, Department of Urology, Jessore Medical College, Jessore, Bangladesh. Received: 9 August 2017 Accepted: 05 March 2018 Introduction Childbirth is a normal physiological process required for the continuation species. But before the advent of modern medical care this normal physiological phenomenon would pose the young femalesto number of child birth injuries of which the urogenital fistula was the most devastating one[5]. These young females, incontinent of urine, ashamed of the rank of personal offensiveness, abandoned by their husbands, outcast of the society, and unemployable except in the field would live and exist without hope and without friend. Since the middle of nineteenth century development of medical science has eliminated this dehumanizing curse from the western European countries and the USA and caused its prevalence to fall precipitously in the more industrialized nations of the Asia and Latin America. The havoc of this horror is still present in the third world countries where access of the pregnant women to the efficient and effective emergency obstetric care isyet to be developed[5]. The prevalence of obstetric urogenital fistula actually reflects the quality of maternal care provided to the pregnant women in a society. Hence the incidence of maternal mortality and thatof obstetric[5] urogenital fistula reveals the same status[5] of the health caresystem of a particular society[5]. The countries where obstetric urogenital fistula has vanished have improved their maternalhealth caresystem significantly along with other6 areas of development[5]. The causes of urogenital fistula in the developed nations are post-surgical, post radiation and malignancy. In Bangladesh the aetiological pattern of female urogenital fistula has changed too reflecting the development of improved maternal health. Bangladesh J. Urol. 2018; 21(2): 71-75 71 Method and materials This retrospective study was carried out during the period extending from January,2010 to December,2015 in a district hospital and a medical college hospital on the female patients operated for different kinds of urogenital fistulae to evaluate the its aetiological aspect in the present health care scenario of the country. Patients presenting with features suggesting urogenital fistulae were evaluated with proper history, meticulous physical examinations and relevant investigations including the followings— Vaginal speculum examination with adequate light.