Spectrum of urologic complications in obstetrics and gynecology: 13 years’ experience from a tertiary referral center

Özet

Objective: To analyze the patterns of presentation and management for urologic complications of obstetricsand gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social is-sues associated with them.Material and methods: We conducted this retrospective study analyzing 311 patients with genitourinaryfistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded thepatients’ characteristics and area of residence and then analyzed the etiology, surgical management and suc-cess rates by grouping the patients into four types of genitourinary fistulas. The primary end point of successwas patient being leak free.Results: Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas indescending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouter-ine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy(32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon’s preference and bothtransabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesi-covaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful.Conclusion: Genitourinary fistulas especially due to obstructed labour are still common in developingworld showcasing the problem of inequitable distribution of healthcare. The surgical treatment approachdepends on the surgeon’s familiarity with the said procedure although versatility is required.