The Trend of Iatrogenic Genitourinary Fistula from 2005 to 2019 and Its Risk Factors at Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia: A Retrospective Study

Abstract

Maranata Dawit Ambaw

Background: Genitourinary fistula is one of a public health importance in low- and middle-income countries. It causes multiple health adversities. Mainly, lack of timely and appropriate intervention such as cesarean section causes genitourinary fistula. Nevertheless, iatrogenic genitourinary fistula is a result of medical error during obstetric and gynecological surgery such as while cesarean section and hysterectomy. This study examined the trend of iatrogenic genitourinary fistula, major surgical procedures leading to iatrogenic fistula and its risk factors.

Methods: a facility based cross sectional study design was deployed. The respondents were included retrospectively using their medical history from January 2005 to December 2019 at Addis Ababa fistula hospital, Addis Ababa, Ethiopia. Data was analyzed using SPSS version 20.0 software. Annual percent change and average annual percent change were calculated using joinpoint regression analysis on joinpoint regression program version 4.8.0.1. Bivariate and multivariable regression model was also undertaken to implore the important risk factors for iatrogenic genitourinary fistula.

Results: Total 9229 fistula patients treated in the hospital. Of which 643(6.96%) and 8,586(93.03%) referred iatrogenic genitourinary fistula and obstetric fistula cases, respectively. The mean age of iatrogenic genitourinary fistula patients was 30.02 (± 4.63 SD) years, ranged 17- 45 years. Among the iatrogenic genitourinary fistula cases, 341(53%) were caused by cesarean section. Other causes were errors while repairing ruptured uterus 131(20.4), during undertaking hysterectomy for ruptured uterus 78(12.1%), and while gynecological hysterectomy 93(14.5%). From 2005 to 2019, there was a significant rising trend in iatrogenic genitourinary fistula (1.55% to 52.9%, p<0.001). Average annual percent change from 2005 to 2019 was 13.2% (95% CI: 7.7, 18.9).Statistically significant risk factors for iatrogenic genitourinary fistula were history of obstetric or gynecologic surgery, type of institution where the surgery conducted, and parity.

Conclusion: The trend of IGF substantially increased while the OF declined over 2005 to 2019 period. Patient safety and quality surgical procedure on pelvic surgeries is paramount important. The study also revealed that CS was the most frequent surgery resulting IGF followed by repairing ruptured uterus, hysterectomy for ruptured uterus and gynecologic hysterectomy.

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