Contributing factors of Vesico-Vaginal Fistula (VVF) among Fistula Patients in Dr.Abbo's National Fistula et Urogynecology Centre - Khartoum 2008

"Background: Vesico-vaginal Fistula (VVF) is defined as an abnormal communicating tract extending between the bladder (vesico-) and the vagina resulting in continuous involuntary discharge of urine into the vaginal vault. Vesico-vaginal fistula is still a persisting scourge in the developing countries; including Sudan in which new cases of obstetric fistula were estimated to occur every year"" #he ob$ectives of this work were to study the contributing factors of vesico-vaginal fistula in Sudanese patients"" Methods: the design was descriptive; cross-sectional; community-based study"" A total of 2 patients with vesicovaginal fistula presented to the Fistula (entre in )Khartoum Teaching hospital from July to August 2 ;; were investigated using an administrated; semi-structured questionnaire"" Results: The study revealed that 44""2of patients were 1;-24 years old; "";were teenagers when married (1; yrs old)"" While 7of the patients were illiterates; 62"";were married to illiterate husbands"" (; "";) were poor; (4 ""4) were from western regions of Sudan"" The study showed that labor was responsible for 9 ""4of VVF of whom 9""6were primiparous; 42""6delivered at home"" It was found that 4 ""4of the total deliveries were by forceps as long as 27""7were emergency caesarian sections"" (3""2) of the deliveries were attended by traditional birth attendants and ""3of cases stayed in labor for more than 24 hours; as long as 3""2were not in regular antenatal care"" Conclusion:The vesico-vaginal fistula in Sudan resulted mainly from obstructed labor"" the victim was mostly a young woman; a primigravida; who was poor; illiterate; not on regular antenatal care et being in labor more than 24 hours"" Most deliveries were carried at home; attended by traditional Birth Attendants in most cases"" the deliveries were mostly assisted by forceps; or conducted as emergency caesarian sections"" To prevent VVF; the study suggested raising awareness of women at bearing age; improve transportation; besides inclusion of the issue in the curricula of schools and universities"""

Results and predictions of success of vesico-vaginal fistula repair at a national reference level in Rwanda

Objective:Vesico-vaginal fistulas (VVF's) cause enormous harm to women in developing countries. This prospective study intends to highlight epidemiological; etiological and pathological data; and to define predictors of surgical results in a national referral hospital setting. Material and Methods:All consecutive patients with VVF presenting at the Kigali Hospital Centre of Rwanda between 1997 and 2001 were included. Data on epidemiology; pathology; therapy and outcome were prospectively obtained. The risk factors for therapeutic failure were identified by multivariate analysis. Results Ninety eight percent of all cases were of obstetrical origin. Twenty five percent of VVF were categorized as simple; 64as complex and 11as complicated. Complete closure and continence were obtained in 87 (77.7) cases and closure with moderate incontinence in 7 cases (6.3). In 18 cases (16) closure failed even after 3 surgical attempts. The independent risk factors for therapeutic failure were vaginal fibrosis (p0.001) and total destruction of the bladder p=0.002).Conclusion: We conclude that failure is basically linked to the level of destruction of the bladder neck as well as the magnitude of pelvic scarring. Surgery of complex and complicated VVF remains a challenge and requires multi-skilled surgeons. The lasting solution is the development of maternity services and the training of health personnel in reproductive health