ABSTRACT
To identify the barriers in seeking definite treatment among the patients with urinary fistulae. Department of Obstetric and Gynaecology, Unit II of Liaquat University of Medical and Health Sciences Jamshoro, Pakistan. From 1[st] January 2007 to 31[st] December 2011. All patients with confirmed urogenital fistulae were included in this cross sectional study by consecutive sampling. A pre designed proforma was used to collect the information about demographic features, causes, duration of fistulae, and reasons for delay in reaching for treatment. SPSS program version 10 was used to analyze the data in terms of frequency and percentage. During the study period there were 5013 gynecology based admissions. 232 of these [4.6% of gynecological admission] were registered cases of urogenital fistulae. After the exclusion of 26 recent cases of urinary fistulae; study was carried out on 206 patients. There were 113 cases of obstetrical fistulae while 93 cases were due to iatrogenic insult during gynecological surgeries. Majority [n=164, 77%] of patients were outside from Hyderabad city. The time lapse from symptoms to presentation at treatment centre was longer than one year in patients with obstetrical fistulae, but was shorter [three to six months] in patients with iatrogenic fistula. The main barrier in seeking early treatments in cases with obstetrical fistulae was lack of knowledge about availability of treatment and treatment centre [87.6%]. Financial constraints [55.7%] and lack of attention by family [42%] were the added barriers. Regarding iatrogenic fistulae, a gross neglect of the attending surgeon was obvious. Majority of the cases were misguided about the problem [n=69, 74%]. Misdiagnosis as a case of chronic vaginal discharge was seen in eleven patients. There is a need to disseminate the awareness particularly at community levels with support of media regarding genitourinary fistulae. Fistulae should not occur but if they do, efforts should be made to shorten the time of this terrifying illness