Circumferential urethral fistulae in Sub-Saharan Africa, current outcomes and future prospects

Introduction and hypothesis Circumferential urethral fistula is a severe form of obstetric injury that is recognized to carry a poor prognosis for eventual continence but this has not been quantified before. Methods An analysis of 106 women who had undergone primary repair of a circumferential fistula was carried out with particular reference to whether there complete continence or at least some improvement in remaining dry was reported. Results Of the 106 women, only 25 % reported themselves continent; 19 % said there was an improvement. Prognosis was not altered by the distance of the fistula from the external urethral meatus, with 10/ 62 (16 % reporting continence if the fistula was <1.5 cm and 10/ 44 (13 %) if >1.5 cm. There was a 13 % primary dehiscence rate. Conclusions Current methods of primary urethral fiistula repair carry a poor prognosis for eventual continence. Techniques to lengthen the urethra and provide greater support need to be developed for this unfortunate group of women.