[Ureterovaginal fistula after caesarean: Diagnosis and management in a resource-constrained hospital in Togo].
The purpose of this study is to describe a simple, non-expensive, accessible and effective technique of ureterovaginal fistula diagnosis, and to assess the results of surgical management in a resource-constrained hospital. During a campaign of obstetric fistulas repair, we diagnosed ureterovaginal fistulas by vaginal exam with the blue methylene test associated to abdominal ultrasonography, two simple and non-expensive explorations which permitted to identify ureterovaginal fistula and to do differential diagnosis with vesicovaginal fistula. The management was surgery, by ureterovesical reimplantation. Four ureterovaginal fistulas have been diagnosed in 32 women presented with obstetrical fistula. The mean age of those fistulas was 4.85 years; it was located on the left ureter in three cases, on the right in one case. The ureteral lesion was consecutive to a caesarean section in all patients and sited on the pelvic segment of ureter. In three patients, diagnosis was performed by the negativity of the blue test and unilateral dilation of ureter and kidney while the discovery was done during the treatment of vesicovaginal and rectovaginal fistulas associated in the last patient. After effects of surgery were simple, characterized by disappearance of urine leakage and dilation of ureter kidney. In resources-constrained context, techniques such as blue test and ultrasonography are enough to perform diagnosis of ureterovaginal fistula. Ureterovesical reimplantation is an effective therapeutic method for diagnosing ureterovaginal fistula.
CHU Sylvanus-Olympio, BP 57, Lomé, Togo. fakpatcha@yahoo.fr.
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Kpatcha
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Tengue
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Adodo
Service de gynécologie-obstétrique, CHR de Sokodé, BP 187, Sokodé, Togo.
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Wangala
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Botcho
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Leloua
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Sikpa
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Sewa
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Anoukoum
CHU Sylvanus-Olympio, BP 57, Lomé, Togo.
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Gnassingbe
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006295:Health Resources; D006801:Humans; D011204:Poverty Areas; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012092:Replantation; D014037:Togo; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D014624:Vaginal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*
Hospital; Kidney ultrasonography; Sub-Saharan Africa; Togo; Ureteral dilation; Ureterovaginal fistula; Ureterovesical reimplantation