Results and predictions of success of vesico-vaginal fistula repair at a national reference level in Rwanda

ABSTRACT

Objective:Vesico-vaginal fistulas (VVF's) cause enormous harm to women in developing countries. This prospective study intends to highlight epidemiological; etiological and pathological data; and to define predictors of surgical results in a national referral hospital setting. Material and Methods:All consecutive patients with VVF presenting at the Kigali Hospital Centre of Rwanda between 1997 and 2001 were included. Data on epidemiology; pathology; therapy and outcome were prospectively obtained. The risk factors for therapeutic failure were identified by multivariate analysis. Results Ninety eight percent of all cases were of obstetrical origin. Twenty five percent of VVF were categorized as simple; 64as complex and 11as complicated. Complete closure and continence were obtained in 87 (77.7) cases and closure with moderate incontinence in 7 cases (6.3). In 18 cases (16) closure failed even after 3 surgical attempts. The independent risk factors for therapeutic failure were vaginal fibrosis (p0.001) and total destruction of the bladder p=0.002).Conclusion: We conclude that failure is basically linked to the level of destruction of the bladder neck as well as the magnitude of pelvic scarring. Surgery of complex and complicated VVF remains a challenge and requires multi-skilled surgeons. The lasting solution is the development of maternity services and the training of health personnel in reproductive health