VVF is of public health importance because the social implications are far reaching. Due
to the constant dribbling of urine and its pungent smell, they are usually ostracized and
considered as outcast.
gave a value of 0.35 of all births in Zaria.
- It affects all ages but more in teenagers
- It affects all parities but more in primips
- Other factors include low social groups, illiteracy, low socio-economic groups
especially rural dwellers
Following a not too recent workshop by experts in Nigera, it was estimated that there are
about 200,000 unrepaired fistulae in Nigeria and about 2 million worldwide.
Estimated third world incidence is 1-2 per 1000 deliveries with about 50,000-100,000
new cases each year.
It may be congenital or acquired.
(A)Congenital eg. Cases of ectopic ureter may discharge into the vagina. It is very rarely
seen and therefore often overlooked.
1. Obstetric: 90% 0f fistulae in the third world.
(i). Negleted Obstructed Labour: Most common cause resulting from pressure
necrosis which follows impaction of the fetal skull in the pelvis = trapping of soft
tissues between fetal skull bones and maternal pelvis.
Immediate effect = Dusty. By 2nd day = dark marking. 3-4th day = sloughing.
Healing phase takes 10-12 weeks. Sepsis makes healing longer.
Traditional practices play a role in the aetiology of obstetric fistulae eg. Gishiri cut on the anterior vaginal wall, cicumcision esp. extreme forms can lead to tears (ant. vag. wall) or obstructed labour.
Irradiation itself may be a cause of fistula. Oblitirative endarteritis =
Ischaemia. This also makes ordinary surgical repair have a high failure
- Juxta urethral
Over 60% of fistulae in 3rd world are mid-vaginal, juxtacervical or massive (reflecting obstetric aetiology) while 50% of fistulae in UK are in vaginal vault (reflecting surgical aetiology).
4. Loin pains
5. Cyclical haematuria
6. Skin- Chronic ulceration
7. Social- Isolation, divorce, worsening poverty, malnutrition, suicide.
UTI is uncommon in VVF patients but should be sought
after and treated before repair is undertaken. Pipette
specimen is taken from the intraversical space.
To examine bladder mucosa, rule out calculi, see exact opening and its relationship to the ureteric orifices and bladder neck.
When the diagnosis is in doubt, this will help to confirm
actual leackage being extraurethral and not urethral and the
site of the leakage.
In confirmed cases, EUA is done to determine
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