Therapeutic Aspects of Urogenital Fistulas at Cheikh Zayed Hospital in Nouakchott, Mauritania

Abstract

The urogenital fistula has undergone several management strategies in Mauritania; we conducted a retrospective, descriptive study evaluating the overall management of urogenital fistulas at the urology department in Nouakchott, Mauritania. The patients included were all women who underwent surgery for urogenital fistula during the period from January 1, 2020, to December 31, 2023. The inclusion criteria included all women operated on for isolated or non-isolated urogenital fistula, recorded in our department during this period. The parameters studied were epidemiological data and history; clinical data; therapeutic and outcome data. We collected 182 cases of urogenital fistulas over a period of 3 years out of a total of 3030 surgical procedures at the urology department, corresponding to 6% of the department’s surgical activity. The average age of our patients was 30 years, with extremes of 17 and 45 years. In our series, 65.93% of the women are primiparas, totaling 120 women. They were 90% from rural areas, which means 164 women; the most affected areas are respectively (hodh ech chargui, hodh elgharbi, gorgol). In our series, 90% of the patients are uneducated, which means 164 women; 6.59% had a primary level of education and only 3.29% had a secondary level. The marital status shows 127 married patients, making up 70%, fifty divorced with a percentage of 27%, and 5 single women, which is 3%. The average duration of having the fistula before treatment was 2 years, with extremes of 5 months to 6 years. The most common recruitment method in our series was through health personnel, accounting for 53.85%, or 98 women. The most frequent diagnostic method in our series was clinical, with a percentage of 70.33%, or 128 patients; examination under anesthesia was performed in 25.28%, or 46 patients, and other examinations in 4.39%, mainly in cases of complications or associated pathologies. In our series, 90% of the fistulas were simple; 8% were intermediate, and complicated forms occurred in 2% of cases. Associated pathologies were noted in 68%. The most frequent obstetric cause was found in 78% of cases, corresponding to 142 cases; followed by iatrogenic causes in 20% of cases. The most commonly practiced approach was the vaginal route in 90.10% of cases; abdominal route in 6.05% of cases, and mixed route in 3.85% of cases. The average duration of hospitalization was 15 days with extremes of 10 to 21 days. After the surgical intervention, the fistula closed in 77% of our patients, which is 140 women. 12% of our patients experienced urinary incontinence, which is 22 women, and we observe a therapeutic failure in 20 cases, or 11%. The cost of managing a single patient with a urinary fistula is approximately $420.