Iatrogenic Female Genitourinary Fistula in Uganda: Etiology, Twelve-Year Trends, and Risk Factors for Development Following Cesarean Section

Abstract

Purpose: To describe the magnitude and trend of the iatrogenic genitourinary fistula in Uganda, and the risk factors for development following the Cesarean Section (CS). Methods: A retrospective review of charts of women with a confirmed diagnosis of genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if it was; ureteric, vesico-cervical, vesico- uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery. The annual proportions for the ischemic and iatrogenic fistula over the study period were compared. A sub group analysis of women with genitourinary fistula delivered by CS was done to determine the factors associated with iatrogenic fistula. Multivariable log binomial regression was performed to determine the independent risk factors. Results: There were 521 women who presented with genito-urinary fistula of which, 169 (32.4%) were iatrogenic. Most of the iatrogenic fistulae followed CS (71%). The proportions of iatrogenic fistulae increased from 8/52 (9.6%) in 2010 to 38/88 (43.2%) in 2020. The risk factors for iatrogenic fistula following CS were; Grand-multiparity (OR = 5.8; 95% CI: 2.1–15.4), Repeat CS (OR = 4.1; 95% CI: 1.8–9.3), CS performed by an intern doctor (OR = 4.8; 95% CI: 1.5–15.5) and CS done at a Health Centre IV (OR = 4.5; 95% CI: 1.2–16.7). Conclusion: The magnitude of the iatrogenic genitourinary fistula in Uganda is high and most follow CS. There is an observed rising trend in iatrogenic fistula. The risk factors for iatrogenic fistula following CS are grand multiparity, repeat CS, CS performed by intern doctors and CS performed at lower health facilities. There is a need for continuous training and supervision of lower cadre doctors involved in CS to reduce on the rising trend of iatrogenic fistula.