Five Years Experience of Ureterovaginal Fistulae Following Obstetric or Gynecological Intervention in Ethiopia

Abstract

Objectives: To study the etiology, presentation and outcome of women presenting to the Addis Ababa Fistula Hospital with an ureterovaginal fistula.
Patients and Methods: Women presenting with ureterovaginal fistulae following obstetric or gynecological intervention. The operating register from June 2004 to July 2009 was studied to identify women who had undergone ureteric re-implantation. Patient files were reviewed and only
women with fistulae resulting from iatrogenic injury were included.
Results: Ureterovaginal fistulae were found in 89 women, 64 after Caesarean section, of which 43 were for a stillborn baby, 12 women have uterine rupture, 6 with instrumental delivery and only 7 with abdominal hysterectomy. The left ureter was most frequently injured (54). The number of patients seen has doubled over the past two years. Using one of four methods of repair, 88 women were continent at discharge from hospital. One died from a suspected pulmonary embolism.
Conclusion: The incidence of iatrogenic ureteric injury is increasing in Ethiopia and most result from Caesarean section. The reasons should be studied. Using a variety of repair techniques, all patients can be cured. However, surgeons undertaking this surgery should have a wide range of
urological training.

Key Words : Ureter, vagina, fistula, latrogenic, caesarean section, hysterectomy, complication