Traore Salifou Issiaka, Dembele Ousmane, Traore Soumaila, Diallo Aly, Maiga Amadou, Sylla Malla, Maiga Adan, Kante Moussa
Service Urologie, Hôpital de Sikasso, Sikasso Ville, Mali.
Pan Afr Med J. 2019 Jun 21;33:133. doi: 10.11604/pamj.2019.33.133.16455. eCollection 2019.
This study aims to analyze the epidemiological, clinical, therapeutic and anatomopathologic features of urogenital fistulas. We conducted a retrospective study of patients with urogenital fistulas admitted to the department of general surgery and gynecology and obstetrics between January 1, 2014 and December 30, 2015, including the first 5 fistula repair campaigns organized by the Fistula Mali project. Urogenital fistulas account for 19.53% of all urologic disorder treated during our daily practice. The median age at first marriage was 16.57 years. The majority of our patients (96.70%) was illiterate and self-employed, coming from rural areas (85.36%). Obstructed labour was the dominant etiology, with 91.50% of stillborn children. The patients were primiparous women (43.33%) and, among them, 53.60% received no prenatal care. The divorce rate associated with the disease was 7.30%. Most patients underwent simple fistulorraphy, of whom 121 underwent lower fistulorraphy, 26 upper fistulorraphy and 3 mixed fistulorraphy. Outcomes were satisfactory in 65.33% patients and poor in 34.66% of patients. Patients with type I and type V obstetric fistulas had the highest healing rate compared to patients with type IV fistulas. Urogenital fistulas are a real public health problem. Treatment is mainly based on surgery and prognosis is compromised by the narrowness of the surgical field, the complexity of the lesions and the condition of the surrounding tissue. The focus must be on the implementation of women's socio economic development programs and on emergency obstetric care access. The research and discussion should continue to facilitate the development of a standard classification.
本研究旨在分析泌尿生殖瘘的流行病学、临床、治疗及解剖病理学特征。我们对2014年1月1日至2015年12月30日期间入住普通外科、妇产科的泌尿生殖瘘患者进行了一项回顾性研究，包括马里瘘管病项目组织的前5次瘘管修复活动。泌尿生殖瘘占我们日常诊疗中所有泌尿系统疾病的19.53%。初婚的中位年龄为16.57岁。我们的大多数患者（96.70%）为文盲且个体经营，来自农村地区（85.36%）。产程梗阻是主要病因，死产率达91.50%。患者以初产妇（43.33%）为主，其中53.60%未接受过产前检查。与该病相关的离婚率为7.30%。大多数患者接受了单纯的瘘管修补术，其中121例行低位瘘管修补术，26例行高位瘘管修补术，3例行混合瘘管修补术。65.33%的患者治疗效果满意，34.66%的患者效果不佳。与IV型瘘患者相比，I型和V型产科瘘患者的愈合率最高。泌尿生殖瘘是一个切实存在的公共卫生问题。治疗主要基于手术，而手术视野狭窄、病变复杂及周围组织状况会影响预后。必须关注妇女社会经济发展项目的实施以及紧急产科护理的可及性。研究和讨论应继续推进，以促进标准分类的制定。
