Obstetric fistula in a district hospital in DR Congo: Fistula still occur despite access to caesarean section.
OBJECTIVE
To study the profile of classification, etiology, and the relation between initial classification, and the results of vesicovaginal fistula surgery in a district hospital in DR Congo.


METHODS
This study was based on the analysis of all consecutive patients being treated for VVF in Kisantu between November 2006 and November 2012. The fistula was classified according to the classification of Waaldijk. The location of VVF and degree of fibrosis were noted. Post-operatively, the first examination of patients took place a few days after catheter removal and subsequent review 2-3 months later. Statistical analysis was done in Graphpad Prism 6.


RESULTS
Among 146 patients with VVF, 117 had a primary fistula. The majority of fistula was type I (56%) followed by type III (21%). The majority underwent a caesarean section (63.4%). The mean duration of labor was 30.7 hr. Delay in getting a caesarean in time was due to difficulties in reaching the hospital in 55%. Overall, the closure rate after the first surgical treatment was 65%. The continence rate of the patients with a successful closure was 63%.


CONCLUSIONS
VVF can occur after caesarean section because of the prolonged labor that already causes ischemia and necrosis of the bladder wall and vesicovaginal septum before or while the caesarean section is being performed. Access to general hospitals and the management of the pregnant women needs to be improved. Despite a reasonable closure rate of 65%, post-fistula incontinence remains an important clinical problem.
Department of Surgery, Urology Division, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo.
Matthieu Nkumu
MN
Loposso
Department of Obstetrics & Gynaecology, Saint Luc Hospital, Kisantu, Democratic Republic of Congo.
Jean
J
Ndundu
Department of Urology, University Hospital Antwerp, Antwerp, Belgium.
Gunter
G
De Win
Department of Urology, St. Blasius Hospital, Dendermonde, Belgium.
Dieter
D
Ost
Department of Surgery, Urology Division, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo.
Augustin Maole
AM
Punga
Department of Urology, University Hospitals KU Leuven, Leuven, Belgium.
Dirk
D
De Ridder
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D036801:Parturition; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014549:Urinary Incontinence; D014719:Vesicovaginal Fistula / Q000145:classification / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
maternal health; obstetric fistula; vesicovaginal fistula