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Iatrogenic Female Genital Fistula, 35 Cases Report

Introduction: Female genital fistula (FGF), remains a world concern, especially in low developed country. Obstructive (blocked) delivery labor is his principal cause, sometimes by pelvic surgery (urogenital or obstetrical, rectal) more rarely by congenital urogenital malformation, excision, pelvic neoplasm, pelvic radiotherapy. We were interested in iatrogenic FGF treated in the special referral fistula center. Methodology: We report 35 cases of iatrogenic female genital fistula. Are included only cases by urogenital surgery, excision in the National Referal Center of Obstetrical Fistula. Were not included cases happened by over 12 hours blocked delivery labor, caustic destruction, pelvic cancer pelvic infection and those with incomplete file. The epidemiologic, clinical and therapeutic information were studied. All ethical protocols were respected. Results: CNRFO recorded 743 cases of female genital fistula from May 23 2013 to May 23 May 2018 within 35 iatrogenic cases (4.71%). Patients were 19 29 years old (42.85%), average age 35 years old, extremes 19 60 years, without occupation (82.86), grand multiparous 48.57%, with a mean of 4 previous deliveries. The principal constancies were hysterectomies 71.43%, caesarean section 17.14%, genital excision 11.42%, and cystocele cure 11.42%. The anatomical finds were soft vagina tissue 97.14% uretero-vaginal fistula 45.71% (2 cases post Caesarean, 14 cases post hysterectomy), vesico-vaginal 31.43% (all post hysterectomy), ureteral 11.42% (all post caesarean), 1 vesico-uterine 5.71% (case post caesarean), 1 case after a cystocele cure, 2 uretro-vaginal 11.42% secondary of genital excision. Treatment was ureteral reimplantation (18/31) cases by abdominal way, fistulorraphy (12/31) and 1uretroplasty by vaginal, 4 cases treated with transurethral bladder probe. 30 were cured by fistulas surgery, 1 urinary tress incontinency and 1 not closed, and 4 of transurethral bladder probe were cured. Conclusion: The female genital fistula is sometimes the consequence of Caesarean, hysterectomy, gynecological surgery, urologic surgery and some traditional practices. How to cite this paper: Idi, N., Abdoulaye, I.., Chaibou Nomao, F. and Assoumane, Z. (2020) Iatrogenic Female Genital Fistula, 35 Cases Report. Open Journal of Obstetrics and Gynecology, 10, 1156-1162. https://doi.org/10.4236/ojog.2020.1090109 Received: July 1, 2020 Accepted: August 31, 2020 Published: Sepetmber 3, 2020 Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
Few morbidities give pain and discomfort to women as genital fistula. Obstetrical origin (dystocia blocked delivery labor) is most frequent. It can be by other circumstances as pelvic cancer, congenital, trauma accident and rarely urogenital infections.
Fistulas is still a public health problem in in-coming countries. Data from the literature on iatrogenic fistulas are still poor. So we were interested in this pathology for the circumstances and prognosis. The study was carried at the National Reference Center for Obstetric Fistulas (CNRFO) in Niamey. This is a retrospective descriptive study (over 5 years) (23/5/2013 -22/5/2018) on iatrogenic female genital fistulas.

Inclusion Criteria
Any female genital fistula noted following gynecological or urological surgery and or traditional practices on the female genital tract (excision), hospitalised in CNRFO during the period concerned and for which the file is usable.

Non-Inclusion Criteria
Any case of female genital fistula occurring during a cesarean section for dystocia blocked labor of more than 12 hours (117 cases), case associated with invasive pelvic cancer (1 case), accidental injury (0 case) by caustic products (0 case) or pelvic irradiation (0 case) and any case of incomplete file (2 cases).

Collection of Data
We collected continuous data at CNRFO for a period of three weeks on the basis of a pre-established survey form and hospital records during the study period.
All ethics procedures were respected.

Results
We recorded 743 cases of genital female fistula at CNRFO, including 35 cases of iatrogenic origin (4.71%) ( The main circumstances were obstetrical (54.28%) mainly the hemostasis (Table 2). Hysterectomy was the main circumstance of uretero-vaginal and vesico-vaginal fistulas, while traditional harmful practice (excision), was responsible for uretro-vaginal fistula (Table 3).

Prognosis
The treatment results after 3 months follow-up noted fistula closed and patient dry in 29 cases (82.87%), 1 case (2.85%) closed with stress incontinency and 1 case (2.85%) non-closed fistula. 4 patients treated by trans urethral bladder probe were dry (11.43%). For Bouya et al. [25], there were 20 cases of healing Open Journal of Obstetrics and Gynecology 76.92%), 3 cases of failure (11.53%), 3 cases with persistence of urinary incontinence despite the anatomical closure of the fistula.

Conclusion
Female genital fistula is a morbidity but not vital danger. It is a big public health problem in Niger country. Our study concerns 35 cases of iatrogenic fistulas in 5 years treated at the CNRFO in Niamey. They are pelvic surgery complications (obstetric, gynecological, urological surgery) and genital mutilation of urogenital tract (excision). The better knowledge of urogenital/female anatomy relative modification may improve pelvic surgery. The surgical techniques and active action against traditional genital mutilation can avoid iatrogenic genital fistula. The treatment result is almost excellent when done by trained and skilled surgeons.
The small vesico-vaginal could be closed by transvaginal bladder probe.