Tropical obstetrics and gynaecology. 3. Vesico-vaginal fistula--a tropical disease.

The predominantly obstetric origin of vesico-vaginal fistulae in the tropics is contrasted with the mainly surgical aetiology of those in Europe by analysis of 543 cases treated in Nigeria and in the United Kingdom. Reasons are given for the high incidence in tropical countries of obstructed labour and hence of vesico-vaginal fistulae. The general management of patients with obstetric fistulae is described, followed by the principles of their surgical treatment and postoperative nursing care. The importance of success at the first attempt at repair is stressed, and the small place for managing failures by urinary diversion is mentioned. It is concluded that obstetric fistulae should be preventable in the tropics, having now been effectively eliminated from industrialized countries.