Genitourinary / Fecal Fistulae: Etiology, Types and Surgical Outcomes

Abstract

Introduction: Genitourinary/ fecal fistula is an abnormal communication between the genital tract and either the urinary tract or the gastrointestinal tract. Among genitourinary fistulae, most common is the vesicovaginal followed by ureterovaginal fistula. Aims & Objectives: The aim of our study is to determine various causes and types of genitourinary/fecal fistulae and their surgical outcome in our setting. Place and Duration of Study: A descriptive, retrospective cross-sectional study was conducted at Central Park Teaching Hospital Hospital, Department of Obstetrics and Gynaecology from December 2013-December 2021. Material & Methods: Total of 77 patients presented with various types of genitourinary/fecal fistulae during the study period. All details as demographic characteristics, type and cause of fistula, route of repair and surgical outcome were taken on a standardized proforma. All data was entered and analyzed in SPSS version 26 for statistical analysis.p-value of less than 0.05 was regarded as significant. Results: In this study, the age range was from 22 to 62 years with mean age 38.38 + 10.67 years. Mean duration of fistula was computed as 45.47 + 71.31 months with the range of 1 month to 27 years (324 months). Average fistula size was 1.14 + 0.96 cm with the range of 0.25 cm to 3 centimeters. The obstetric causes of fistulae accounted 44% (n=34) while iatrogenic causes were seen in 56% (n=43) of patients. The most common type of fistula was VVF with 53 (69%) patients followed by uretero-vaginal fistula with 08 (10.0%). The least common type of fistula was urethro-vaginal with only 01 (1%) case of 22 years, 05 (7%) patients had RVF and 08 (10%) had vesico-uterine and vesico-cervical fistulae. the overall success rate is 88.3%. Conclusion: The iatrogenic causes of genitourinary/fecal fistulae are more prevalent than obstetric causes. The successful outcome of fistula repair depends on number of previous attempts of repair and outcome of repair worsen with each number of previous attempts.