Decreasing incidence and changing aetiological factors of vesico-vaginal fistula in south-east Nigeria.

This study retrospectively reviewed 476 cases of vesico-vaginal fistula (VVF) in the University of Nigeria Teaching Hospital Enugu, south-east Nigeria from 1981 to 2005. The majority (86.6%) of the VVFs were of obstetric origin, resulting from vaginal delivery (n = 330), caesarean section (n = 35), caesarean hysterectomy (n = 26) and instrumental delivery (n = 21). The remaining 13.4% (n = 64) resulted from pelvic surgery, malignancy and radiotherapy treatment. The contribution of obstetrics to VVF development showed a downward trend from 95% in 1981 to 60% in 2005. A success rate of 83% was recorded in the repair with large sized fistula and extensive fibrosis at the fistula site contributing mostly to failure. There is a need to increase access to trained delivery attendants to sustain the downward trend in the incidence of VVF.