Evaluation of the Surgical Management of Urogenital Fistulas in Southern Senegal

Introduction: Urogenital fistula (UGF) encompasses multiple clinical forms, most often of obstetric origin. It represents a major public health problem in sub-Saharan Africa, in contrast to its rarity in high-income countries. This study aimed to evaluate the outcomes of surgical management of UGFs performed by a specialized missionary team in Casamance (Senegal). Methods: Our study was a cross-sectional, descriptive study targeting women with a uterine fistula who required surgery by the mission team (December 2019 to December 2021) in the Casamance region. It excluded women with associated rectovaginal fistulas. The variables studied were epidemiological, obstetric, anatomoclinical, therapeutic, and outcome-related. Data were collected from reports and surgical records. Results: Forty-six cases were included. The mean age was 39 years. Female genital mutilation was reported in 52.2% of cases (primarily type I). Prolonged labor (more than 12 hours) occurred in 82% of cases, and 80% of deliveries took place in a hospital setting. Vesicovaginal fistulas accounted for 86.9% of cases, and obstetric causes for 82.6%. Vaginal access was used in 69.6% of cases, and the Chassar-Moir technique in 76.1%. The overall success rate was 78.3%, with urinary leakage occurring in 21.7% of cases. No postoperative incontinence was observed. Conclusion: Urogenital fistulas lead to serious physical and psychosocial consequences. Their prevention requires prompt and competent obstetric care. The results of this mission are encouraging and highlight the need to strengthen local surgical capacity.