Prevalence and Experience with Ureteric Fistula in a Comprehensive Obstetric Fistulae Care Facility in Jos North- Central Nigeria

Abstract

Urinary incontinence resulting from genital fistulae has been on the increase for over a decade now due to increased fistula care and treatment awareness and improvement in access to care and treatment coupled with community awareness program in which care and treatment intervention are now made possible close to where the sufferers of fistulae live. A study carried out in our facility in 2007 showed an annual fistulae case of about 300, while we currently diagnose between 400 and 500 cases annually. Besides vesicovaginal fistula (VVF) which is the commonest female genital fistula, ureterovaginal fistula (UVF) appears to also be on the increase. We therefore carried out a review of the diagnosis and surgical outcomes of ureteric fistulae in order to ascertain the proportion of the female genital fistulae that are UVF in order to proffer possible preventive measures. We also determined the surgical success rates of ureteric fistulae cases repaired at Bingham University Teaching Hospital. This retrospective study was conducted between January; 2017 and December; 2022. We reviewed the medical records looking at the final diagnosis of all fistulae cases diagnosed over the period, diagnostic methods and causes of ureteric fistulae, including their follow up data for six months post-surgery. All the data extracted from the patients’ medical record were analyzed using IBM SPSS version 26.Over the period of review, 2445 fistulae cases were diagnosed out of which 103 were ureteric fistulae/uretero-vaginal fistula (UVF) giving us a prevalence of 4.2%. The leading aetiological factors were caesarean delivery 74(71.8% of 103), Myomectomy 13 (12.6% of 103) and congenital 9 (8.7% of 103). The surgical success rate was 98.1% both at 3 and 6 months post-surgical repair. From the study, Caesarean delivery is a common procedure in obstetric and delivery practice after vaginal delivery and was responsible for 71.8% of 103 UVF found in our study. Ureterovaginal fistulae have become a worrisome cause of urinary incontinence and the left ureter affected more than the right ureter. The high success rate of 98.1% of 103 cases and less morbidity recorded is a reflection of surgical competency and efficiency of the Fistulae care and treatment team at the centre.