RESUMO
To determine the demographic features, etiologic factors and management outcome of women who presented with genital flstulae. A descriptive study. Unit III, Department of Obstetrics and Gynaecology, Federal Government Services Hospital, Islamabad. 10 years, January1996 to December 2005. Record of 23 patients who presented with genital fistulae was reviewed The inclusion criteria was fistulae of size 1.5 cm or less in diameter; secondary to obstetric or pelvic surgery trauma. Complete history and vaginoscopy was done. In women presenting in early phase [<3 months], conservative management. Intravenous urography [IVU], examination under anesthesia [EUA], cystourethroscopy and three swab test was done in all patients who required surgical management. Fistula was repaired through vaginal route in majority of cases. Abdominal procedure was carried out for ureterovaginal, vesicouterine and complex vesicovaginal fistulae. Outcome of procedures and their postoperative complications were recorded Twenty three patients presented with genital fistulae, 18 [78.2%] had obstetric causes while five [21.7%] developed fistula after pelvic surgery [hysterectomy]. Amongst obstetric patients, 15 [83.3%] belonged to rural areas around the city. Mean age was 24.78 +/- 4.41 years and 13 women [72.2%] belonged to age group 21-30 years. Obstructed/prolonged labour was the most common cause [94.4%]. In pelvic surgery group, 80% of the patients belonged to age group>40 years[mean age 44.60 +/- 3.51 years]. Conservative management was successful in all five patients, who presented in early phase [<3 months]. Successful surgical repair was observed in 92.8% cases in obstetric and 75% in pelvic surgery group. Neglected obstetric management due to deficient maternity services is the leading cause of genital fistulae. Following a proper management protocol of emergency obstetric care, successful outcome in majority of cases cane be achieved