This study showed that most women with vesicovaginal fistula were older than 18 years. This finding is different from the previous studies where majority were teenage and predisposed to contracted pelvis and as a result obstructed labor which is the commonest cause of obstetric fistula in sub Saharan Africa [2, 3, 23]. Though the great proportion of patients gave birth for two or more times, more than a third gave birth for the first time. This might be explained by the fact that both primigravidity and multiparity were identified risk factors for obstetric fistula [20]. In this study, majority of patients had prolonged labor (80 %) which lasted for two or more days, delivered in the health facility (72 %), and about 86 % of deliveries were ended up in still births. These findings are similar with studies from sub-Saharan Africa [3, 4] except for the high rate of still birth in this study, which can be explained by the low health facility delivery rate of Ethiopia (10 %) [4], and in the current study, majority of patients were referred after prolonged labor either for uterine rupture or obstructed labor or feto-pelvic disproportion. These complications could have been averted by availing comprehensive emergency obstetric and new born care in each district [10, 24]. However, the still birth rate in the current study is lower than the previous study done in Ethiopia and Nigeria where the still birth rate is reported to be 93 % and 91.7 % respectively [3, 5].
From among forty six percent of abdominal deliveries, uterine rupture accounted for 23.8 %. This rate is very high when compared to other studies in Africa [20] and explained by the fact that most mothers had stayed laboring at home for long time and decided to seek health care late after complications has already developed [10, 11]. Fifty six percent of patients had mid-vaginal vesicovaginal fistula followed by circumferential vesicovaginal fistula and eight percent of patients had previous one fistula repair. These findings are similar with other studies done in Africa where 47 % of fistula was midvaginal [12, 14]. However, patients having previous failed repair are lower in this study compared to a study in Nigeria [16]. This may be explained by the fistula patients’ characteristics in the current study whereby most patients had simple fistula by Goh of Ibi (30.7 %) followed by Iai (17.3 %), though 4.8 % had IVbiii.
One aspect of surgical repair in particular, the route of repair undertaken, is critical as the abdominal (versus vaginal) approach may be associated with longer term hospitalization, Urinary tract infection (UTI) and increased blood loss [13, 21]. Type of anesthesia used is also an important factor which affects postoperative morbidities. In the current study, nearly 96 % had their repair transvaginally, 71 % under spinal anesthesia, when compared with most studies in other African countries [16]. Transvaginal route and spinal anesthesia is most widely used in the current study. This difference might be related to the background and experience of the fistula surgeon whereby some can perform almost all repairs vaginally including juxta cervical fistulas while others may prefer abdominal approach. However it is similar with a multistage study done in developing countries [14] where the vaginal approach accounts for 95.52 %. These might have contributed to the low postoperative morbidity (9.5 %) in the present study.
Nearly 38 % (15/40) of patients presented with uterine rupture had bladder rupture and only 4 patients had iatrogenic vesical fistula during cesarean section. In general, surgical skill of operating surgeon at the time of cesarean section is critical to avoid iatrogenic bladder fistula. The iatrogenic vesical fistula in this study is by far lower than the reports in most studies in Africa [16, 17]. Presence of neurologic injury mostly shows the severity of obstructed labor complex and may affect the repair outcome as well. In our study, the neurologic injury rate is 4 % which is very low when compared with a previous study done in East Africa [2, 17]. The difference can be explained by the fact that most patients in our study had simple fistula Goh Ibi followed by Iai which tells the degree of injury to the birth canal.
The overall fistula closure rate varies from center to center which may be affected by fistula characteristics and the experience of the surgeon. In the present study the overall closure rate was 93.4 % and 8.9 % of the patients developed urinary incontinence though their fistula was healed at discharge. This finding is comparable with studies in Africa [3, 17, 22] though there are reports of low fistula closure rate in another study [2, 20, 12].
In this study, some socio-demographic and Obstetric characteristics of fistula patients were missed because it was not filled up at the time of admission. In addition long term outcome was not assed because almost all patients would not come back for subsequent visits.
