Contribution of Iatrogenic Cause to Female Genital Fistula Burden in a New Classification System

Session: Iatrogenic Fistula: New Landscape, Emerging Challenges Confront Fistula Care Programs

Presenter: Sanda Ganda, Hopital National de Lamorde Niamey
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Background: There is increasing interest amongst female genital fistula stakeholders to understand outcomes of fistula repair surgery as well as the contribution of iatrogenic causes.

Methodology: This was a prospective study on more than three hundred patients registered between June 2011 and June 2014 at Hopital National de Lamorde and the Central National Referral Center for fistula in Niger. Outcomes assessment was based on an unpublished classification system (to be described in this presentation) using four criteria (fistula environment, size, illustration and prognosis).

Results:  More than three hundred women underwent fistula repair; 94. 4% through vaginal route. Six types of fistula were described under this classification system, with Iatrogenic Fistula falling under the label ‘Type VI’ and contributing to 5.4% of the fistula. A small proportion of the women (7.7%) were lost to follow-up at three months, but most had successful closure as well as continence. The 6.7% closing failure rate was frequent in types III and V. Post-surgery urinary incontinence was found in 21.30% (more common in types II, III, IV and V).

Conclusion:  Iatrogenic fistula is not yet recorded as frequently as in some regions, such as Southern Asia, but is becoming an issue with significant concerns for treatment and prevention. Some aspects make it stand out as a type of fistula different from the other categories.