Vesico – Vaginal and Recto-Vaginal Fistulas

Incidence and Prevalence

Traditionally fistulas occur in the developing world in association with obstetric injury [1, 2]. A tremendous disparity exists between risks associated with pregnancy and labour faced by women in the developing world compared to women from wealthier nations. For example, over the course of a lifetime, 1 in 30, 0000 Scandinavian women will die in pregnancy or labour. For a woman from Africa, the risk is 1 in 12. However, for every woman that dies in labour in the developing world, many more find their lives destroyed by terrible injuries because of untreated obstructed labour. Access to modern obstetric care is limited for much of the world, and availability of a timely caesarean section is virtually impossible. The pressure of the foetal head during obstructed labour causes ischemia to the pelvic organs, and a spectrum of injuries ensues. These include vesico-vaginal (VVF), recto-vaginal (RVF) and urethro-vaginal (UVF) fistulas wich are abnormal communications between the vagina and the bladder, rectum and urethra respectively.

In Africa, the prevalence rate is higher in rural areas due to poor obstetric facilities. Furthermore, long distances combined with high cost of care, and poor nutrition make women more vulnerable to VVF.  Unreliability and scarcity of data has meant that accurate numbers of those afflicted is not available.  Although victims of this condition can be found across the length and breadth of the continent, there appears to be a concentration of sufferers in northern Nigeria [3] and other West African states, countries in the horn of Africa and middle belt regions of the continent, as well as parts of the indian sub-continent [4, 5, 6]. Contributory factors include poverty, gender discrimination, lack of education, cultural or traditional practices and access to health services[7]. The developed world is only now becoming aware of the devastation to women’s lives, largely because women in the developing world have had no voice in the international community.

In the developed world, fistulas usually occurr as a complication of pelvic surgery, radiotherapy or foreign body injury. As antenatal care is so advanced in these countries, obstetric trauma is not a common aetiological cause of fistulas in the developed world.

The main treatment for all types of fistulas remains surgical repair which is carried out under meticulous circmstances. The success of the repair is not only dependant on good surgery, but also on excellent nursing care and prevention of complications [8]. When complications arise, patients can end up with extensive surgrey often requiring urinary or colo-rectal by-pass surgery. Hence, that is why it is imperative that they are prevented.