Skip to main content
SpringerLink
Log in

The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

The aim of the study was to determine the clinical epidemiology of genitourinary fistulae as seen at Komfo Anokye Teaching Hospital in Kumasi, Ghana. A retrospective study was carried out from the hospital records and operative reports of all patients with genitourinary fistulae seen at Komfo Anokye Teaching Hospital between January 1977 and December 1992. Patient age, parity, type of fistula and cause of fistula were abstracted from the medical records. There were 164 cases of genitourinary fistula managed during the study period. There were 150 fistulae due to obstetric causes (91.5%), the vast majority of which were due to prolonged obstructed labor (121 cases, 73.8% of all fistulae), with a minority related to complications of lower-segment cesarean section (14 cases, 8.5% of all fistulae). In 5 cases (3.1%) patients developed a rectovaginal fistula owing to perineal tears and prolonged obstructed labor. During this time period there were 157 449 deliveries, giving an obstetric fistula rate of 1 fistula per 1000 deliveries. Obstetric fistulae were most common at the extremes of reproductive age and parity. Fourteen additional fistulae (8.5% of all cases) were due to gynecologic causes, most commonly from surgical injury occurring at the time of abdominal hysterectomy for leiomyomata uteri (12 cases, 7.3% of all fistulae). It was concluded that in Kumasi, Ghana, obstetric trauma from prolonged obstructed labor is the most common cause of genitourinary fistula formation. Such fistulae occur in older multiparous women as well in young primigravidae. Obstructed labour can, and does, occur in women who have previously undergone uneventful vaginal delivery. Birth attendants should be aware of that fact. Prompt referral for obstetric intervention should be made in obstructed labor, irrespective of the age and parity of the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tazhib F. Epidemiological determinants of vesicovaginal fistulae.Br J Obstet Gynaecol 1983;90:387–391

    PubMed  Google Scholar 

  2. Tahzib F. Vesicovaginal fistula in Nigerian children.Lancet 1985;2:1291–1293

    PubMed  Google Scholar 

  3. Harrison KA. Obstetric fistula: one social calamity too many.Br J Obstet Gynaecol 1983;90:385–386

    PubMed  Google Scholar 

  4. Waaldijk K, Armiya'u YD. The obstetric fistula: a major health problem still unsolved.Int Urogynecol J 1993;4:126–128

    Google Scholar 

  5. Ampofo EK, Omotara BA, Otu T, Uchebo G. Risk factors of vesico-vaginal fistulae in Maiduguri, Nigeria: a case-control study.Tropical Doctor 1990;20:138–139

    PubMed  Google Scholar 

  6. Briggs N. Illiteracy and maternal health: educate or die.Lancet 1993;1:1063–1064

    Google Scholar 

  7. Murphy M. Social consequences of vesico-vaginal fistula in northern Nigeria.J Biosoc Sci 1981;13:139–150

    PubMed  Google Scholar 

  8. Harrison KA. Child-bearing, health and social priorities: a survey of 22, 774 consecutive hospital births in Zaria, northern Nigeria.Br J Obstet Gynaecol 1985;Suppl 5:1–119

    Google Scholar 

  9. Wall LL. Hausa medicine: illness and well-being in a West African culture. Durham, NC: Duke University Press, 1988:185

    Google Scholar 

  10. Martey JO, Elkins TE, Wilson JB, Adadevoh SWK, MacVicar J, Sciarra JJ. Innovative community-based postgraduate training for obstetrics and gynecology in West Africa.Obstet Gynecol 1995;85:1042–1046

    PubMed  Google Scholar 

  11. Arrowsmith SD. Genitourinary reconstruction in obstetric fistulae.J Urol 1994;152:403–406

    PubMed  Google Scholar 

  12. Bieler EU, Schnabel T. Pituitary and ovarian function in women with vesicovaginal fistulae after obstructed and prolonged labour.South Africa Med J 1976;50:257

    Google Scholar 

  13. Waaldijk K, Elkins TE. The obstetric fistula and peroneal nerve injury: an analysis of 947 consecutive patients.Int Urogynecol J 1994;5:12–14

    Google Scholar 

  14. O'Driscoll K, Jackson RJA. Prevention of prolonged labour.Br Med J 1969;2:477–480

    PubMed  Google Scholar 

  15. Goodwin WE, Scardino PT. Vesicovaginal and urterovaginal fistulae: a summary of 25 years of experience.J Urol 1980;123:370–374

    PubMed  Google Scholar 

  16. Donald I. Disproportion. In: Practical obstetric problems. London: Lloyd-Luke, 1979:75–89

    Google Scholar 

  17. Philpott RH, Castle WM. Cervicographs in the management of labour in primigravidae I. The alert line for detecting abnormal labour.J Obstet Gynaecol Br Commonw 1972;79:592–598

    PubMed  Google Scholar 

  18. Philpott RH, Castle WM. Cervicographs in the management of labour in primigravidae II. The action line and treatment of abnormal labour.J Obstet Gynaecol Br Commonw 1972;79:599–602

    PubMed  Google Scholar 

  19. Drouin P, Nasah BT, Nkounawa F. The value of the partogramme in the management of labor.Obstet Gynecol 1979;53:741–745

    PubMed  Google Scholar 

  20. Djuardin B, De Schampheleire I, Sene H, Ndiaye. Value of the alert and action lines on the partogram.Lancet 1992;330:1336–1338

    Google Scholar 

  21. Kwast BE. World Health Organization partograph in management of labour.Lancet 1994;343:1399–1404

    PubMed  Google Scholar 

  22. World Health Organization. Essentials of obstetric care at first referral level. Geneva: WHO, 1985

    Google Scholar 

  23. Royston E, Armstrong S (eds). Preventing maternal deaths. Geneva: WHO, 1989.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University of Science and Technology School of Medical Sciences, Kumasi, Ghana

    K. A. Danso & J. O. Martey

  2. Department of Obstetrics and Gynecology, Louisiana State University Medical Center, 1542 Tulane Avenue, 70131, New Orleans, LA, USA

    L. L. Wall & T. E. Elkins

Authors
  1. K. A. Danso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. O. Martey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. L. Wall
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. E. Elkins
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

EDITORIAL COMMENT: This is an interesting article with respect to its elucidation of the etiology of various fistulae, both obstetric and gynecologic. In addition, the elevated numbers of fistulae in multiparous patients (in this series over 50% of the cases) draws attention to this problem population. Indeed, nearly a quarter of these patients were women who had had 5 or more children. All this points to the importance of early intervention with respect to the conduct of labor in patients with a potential for prolonged obstructed labor. Also of interest is the high number of ureterovaginal fistulae associated with abdominal hysterectomy for uterine fibroid. This emphasizes the importance of surgical technique to avoid damage to the upper urinary tract during gynecological surgery. Devitalization of the ureter from damage to its blood supply or direct damage to the ureter are responsible for this problem. These factors should be either avoided or appropriately identified and corrected at the time of surgery.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Danso, K.A., Martey, J.O., Wall, L.L. et al. The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992. Int Urogynecol J 7, 117–120 (1996). https://doi.org/10.1007/BF01894198

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01894198

Keywords

Search

Navigation