RESULTS OF TREATMENT IN 182 CONSECUTIVE PATIENTS WITH GENITAL FISTULAS

Objectives: To evaluate genital fistulas with the aim of improving str ategies to prevent them. Method: An institutional, retrospective, clin ical analysis. One hundred eighty-two patients with genital fistulas m anaged consecutively between 1970 and 1993 were analyzed. Results: Abo ut 60% of all fistulas were attributable to obstetric traumas whereas gynecologic surgery constituted only 24.7% of cases. The contribution of gynecologic surgery increased from 11.1% in 1970-75 to 60.6% in 198 8-93. Approximately half of the patients had vesico-vaginal fistulas. Of the 45 patients with fistulas occurring following gynecologic surge ry, 19 had undergone simple hysterectomy and eight had undergone radic al hysterectomy. All cesarean sections had been performed after failed labor. Hysterectomy was performed due to myoma in nine patients, endo metrial hyperplasia in two patients and pelvic relaxation in eight pat ients. As regards management of fistulas, the transvaginal approach wa s chosen in the vast majority of patients. The overall success rate af ter the primary repair of fistulas was 91.5% (162/177). Fifteen patien ts with failure of the primary repair were subjected to repeat repairs . The second repair was successful in II patients but the remaining fo ur needed further repairs. The maximum was seven repairs to a recto-va ginal fistula before a satisfactory result could be achieved, which ha d initially occurred after a cesarean section. Conclusion: Although th e results of reparative surgery are promising, it would be more useful to encourage national measures to prevent in particular obstetric tra uma.