Etiology of genitourinary fistula: experience from Rangpur Medical College Hospital

Background: Genitourinary fistula is one of the most distressing complications encountered in obstetrics and gynecology and constitute a major surgical challenge for the gynecologist. With advanced obstetric care, genitourinary fistula is rare in industrialized world but it is still a major health problem in underdeveloped countries, particularly in sub-Saharan Africa and Asia including Bangladesh. The aim of the study was to evaluate the etiology and risk factors of female genitourinary fistula a tertiary hospital of Bangladesh. To undertake a baseline evaluation of all genitourinary fistula cases and to evaluate the etiology and risk factors for development of genitourinary fistula. Methods: This cross-sectional observational study was conducted at the inpatient and outpatient department of obstetrics and gynecololgy, Rangpur Medical College and Hospital, Rangpur from August 2018 to January 2019. A total 30 genitourinary fistula cases were admitted. All patients attending during the study period full filling both the inclusion and exclusion criteria in this study. In this consecutive sampling technique data was collected, coded, revised and entered into the statistical package for social science (SPSS) version (22). Results: This study showed the mean age was 29.06 years and the majority was relatively young. Almost half (56.7%) of them were illiterate and majorities’ husbands were agriculture (63.3%) or worker (26.7%). Majority had height in the range of ≤45 cm and almost all (87.6%) weighted below 50 kg. Vast majority (63.3%) of were multipara. Obstetrical conditions were the causes in the majority (80%) and gynecological factors were the causes in the remaining (20%). Although following cesarean section (29.2%) and rupture of uterus (12.5%) are important causes, obstructed labour still now constitutes the vast majority (58.3%) of the obstetric causes. Total abdominal hysterectomy constitutes the majority (66.7%) of the gynecological causes. Majority (86.7%) of the studied women did not receive antenatal care. Conclusions: Although, the genitourinary fistulas in this study were majorly of obstetric origin, a relatively high proportion of cases were of iatrogenic origin. Government should provide universal access to timely and appropriate obstetric care, and also empower women.