Obstetric fistulae: a practical review

Abstract

Fistula related to childbirth, once prevalent in North America and Europe, remains a significant women’s health problem in developing countries today most notably in sub-Saharan Africa. A recent United Nations Report estimates that two million women are living with the condition. Described by the World Health Organisation as the “forgotten disease,” the identification of patients, assessment, surgical treatment and rehabilitation remain challenges to gynaecologists and governments responsible for providing adequate resources for treatment and rehabilitation.

This article describes the epidemiological, psychological, physical, reproductive and socio-cultural factors associated with obstetric fistulae and its clinical management. Following a discussion of the prevalence, aetiology and diagnosis of the condition, the classifications and sub-classifications of the different types of fistulae, specifically vesico-vaginal and recto-vaginal fistulae, are explained.

The section on surgical repair of both types of fistulae covers the pre-operative assessment, timing of the repair and the basic operative principles. Details of the basic technique for repair and the different graft techniques are described.

Finally, the authors make a case for the development of special units dedicated to the comprehensive treatment and rehabilitation of women who have obstetric fistulae. As well, these units must provide training units for doctors and, nurses and other health professionals from countries where obstetric fistula as a consequence of birth is prevalent.