Iatrogenic Genitourinary Fistulas: An 18 -year Retrospective Review

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

Presenter: Thomas Raassen, Independent Consultant
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Background: An iatrogenic fistula is a fistula resulting from surgery performed by a medical person. In this presentation we discuss fistulas in women between bladder/ureter and uterus/cervix/vagina. The operations, during which the fistula occurred, are: 1) Caesarean Section (CS), 2) CS/hysterectomy for ruptured uterus and 3) hysterectomy for gynecological reasons. There are 3 types of iatrogenic fistulas: a) uretero-(cervico)-vaginal fistulas, b) vault fistulas and c) vesico-(utero)-cervico-vaginal fistulas (VCVF).

Methodology: Between June 1994 and August 2012, 5959 women were operated on for VVF/RVF and related conditions in over 40 hospitals in East Africa and Asia. The data of all 805 women with iatrogenic fistulas were analyzed.

Results: There were 273 (33.9%) of 805 women with ureteric injuries. Most of them were repaired via a laparotomy. 181 (22.5%) women had vault fistulas. Only 12 of them were operated via a laparotomy. 351 (43.6%) women had a VCVF. Less than half were operated abdominally. In this series an overall 13.2% of the women had iatrogenic fistulas. Several other data will be presented, including previous abdominal surgery, types of repair and the results.

Conclusions:  Iatrogenic fistulas form a separate group. The training of medical staff performing CS and hysterectomies needs improvement. Gynecologists, surgeons and urologists are able to repair iatrogenic fistulas. The overall cure rate is high.