Obstetric fistulae repair in a Nigerian Tertiary Health Institution; Lessons learnt from the outcome of care
This was a hospital based retrospective study of one hundred and fifty-five women managed for obstetric vesicovaginal fistula at the University College Hospital, Ibadan Nigeria from 2000 till 20006. The objective of the study was to document the types of obstetric vesico-vaginal fistula and also describe factors that may influence the outcome of successful repair.
The pattern of the fistulae managed were Midvaginal (45.8%), juxtacervical (38.7%) and juxtaurethral (15.5%). Gynaecologists performed 61.7% of cases using the vaginal route while urologists repaired the rest abdominally. Bivariate analysis showed that younger age at presentation, gravidity, VVF type (Anatomic and Kees Waaldijk), number of previous repairs, and presence of rectovaginal fistula and duration of urinary incontinence prior to repair were statistically significantly related to outcome of repair. Multiple logistic regression models revealed age at presentation (95% CI OR = 1.18 – 9.09) and duration of incontinence (95% CI OR = 1.39 – 13.64) as significant predictors. It is recommended that early presentation for repair and capacity building of specialist trainees will assist in the effective management and other interventions to eliminate obstetric fistula. Above all, governments at all levels should either subsidize or make antenatal care free so as to reduce the incidence of childbirth complications including vesico-vaginal fistula.
Keywords: Obstetric fistula, vesico-vaginal fistula (VVF), obstructed labour