Genital tract fistula: a case series from a tertiary centre
in South Africa
Thinagrin Dhasarathun Naidoo
Received: 2 March 2017 / Accepted: 3 June 2017 /Published online: 10 July 2017
The International Urogynecological Association 2017
Introduction and hypothesis We describe the demographic
profile, aetiology, management and surgical outcomes in
women with genital tract fistula presenting to a tertiary
Methods This retrospective audit included 87 patients man-
aged in our unit between 2008 and 2015. Frequencies and
means with standard deviations are presented for categorical
and continuous data. Continuous dependent variables are cat-
egorized as above or below the median for bivariate analyses
performed using the chi-squared test (α =0.05).
Results The mean age of the women was 34.7 years, 64.4%
were Black African, 70.2% were multiparous, 49.4% were
married, 82.8% were employed, and 21.8% were HIV-infect-
ed, with 47.4% on antiretroviral treatment. Vesicovaginal
(47.1%) and rectovaginal (41.4%) fistula were the most fre-
quent injuries. The majority of the injuries (67.8%) were ob-
stetric, with 26.4% occurring during caesarean delivery.
Repair had been attempted previously in 43.7% of patients.
In 63.2% of the repairs the approach was vaginal and in 35.6%
abdominal. Interposition grafts were used in 23% of repairs. In
85.1% of patients the initial repair at our centre was success-
ful. Patients with multiple repairs were more likely to have
complications (p = 0.03). HIV infection was not significantly
associated with complications.
Conclusions A high rate of successful repair was found, with
previous unsuccessful repairs associated with poorer out-
comes, highlighting the need for centralized management.
Genital tract trauma in women results in debilitating, emotion-
al, psychological and social problems, which impacts nega-
tively on the quality of life of affected individuals [1–4]. The
anatomical proximity of the bladder, rectum, vagina and uter-
us make the genital tract susceptible to trauma during compli-
cated childbirth and difficult gynaecological surgery [1, 5, 6]
The resultant fistula, with associated urinary or anal inconti-
nence are a major health problem in women across all eco-
nomic and social divides. A genital tract fistula is an opening
between a woman’s genital tract and either the urinary (ureter,
bladder or urethra) or the intestinal (rectum) tract [1, 4, 7, 8].
In resource-constrained settings these injuries are mainly of
obstetric origin, whereas in well-resourced settings,
gynaecological surgery and radiotherapy account for the ma-
jority [3–6, 8–10]. It has also been shown that repair is more
likely to be successful if the patient has not been operated
upon prior to referral to a specialist centre [3, 5].
Data from this study were presented at the RCOG World Congress 2017,
Cape Town, South Africa, 19–23 March.
* Thinagrin Dhasarathun Naidoo
Department of Obstetrics and Gynaecology, Greys Hospital,
Pietermaritzburg, South Africa
Nelson R Mandela School of Medicine, University of Kwa
Zulu-Natal, Durban, South Africa
Department Obstetrics and Gynaecology/Women’s Health, Nelson R
Mandela School of Medicine, University of Kwa Zulu-Natal,
Durban, South Africa
Department of Public Health Medicine, School of Nursing and Public
Health, University of Kwa Zulu-Natal, Durban, South Africa
Int Urogynecol J (2018) 29:383–389