Genital Tract Fistulae in the Republic of Yemen, Sana`a

The purpose of this study was to investigate the type, frequency, causes and treatment outcome of patients with GTF at Republic of Yemen, Sana`a. A survey of 55 cases of GTF in Sana`a, the capital of Yemen over the past 8 years was carried out through retrospective study from three big hospitals (from January, 1997 to December, 2004). The cases were analyzed with respect to the causes, the type, the mode of management and the clinical outcome of the genital tract fistula. GTF is more common in Republic of Yemen. Most of GTF are related to obstructed labor due to unattended deliveries, small pelvic dimensions, mal-presentation, poor uterine contractions and cephalo-pelvic disproportion. Total 98 cases were collected from three big hospitals in Sana`a over the past 8 years, 43 cases were excluded (without sufficient data). In a series of 55 women with GTF, fistulas were related to obstetric events in 83.64%, gynecologic surgery in 10.91%, trauma in 1.82% and unknown cause in 3.64%. Of the 55 patients with GTF, 51 cases were urogenital fistulae (41 cases of vesico-vaginal fistulae, 10 cases of other types), 3 were recto-vaginal fistulae and one case had concomitant urogenital and recto-vaginal fistulae. Among the 55 cases of GTF, 51 patients had been undertaken surgical fistula repair and 4 patients without operations for systematic diseases. As a result, 30 of 51 cases were successfully repaired at first surgery. All 21 cases were performed second-step repairs, 11 cases were completely cured and 10 cases were failed finally, Total 80.4% of success rate was achieved. In addition, the stress urinary incontinence developed in 7.3% of cases. Obstructed labor remains the most important cause of GTF in Yemen. It is important to prevent GTF arising from obstructive causes. The surgical treatment of genitourinary fistulae will depend upon the type, size and location of fistula. It is acceptable to repeat the repair surgery through a vaginal approach even after the first vaginal approach failure.