Lower genito-urinary fistulae.

A retrospective review of 120 patients diagnosed to have lower genito-urinary fistulae, over a period of 42 years, was performed. The patients were seen at the University Maternity Hospital or the Zahrawi Maternity Hospital, Damascus, Syria. The majority of the patients, particularly in the early part of this period, had obstetrical causes (90.5%), mainly due to obstructed labour, difficult and traumatic forceps deliveries, ruptured uterus and bladder and/or lower segment caesarean section (LSCS). Less frequently encountered gynecological causes, in the same early period, were due to total abdominal hysterectomy (TAH), Wertheim radical hysterectomy (WRH), anterior vaginal repair, sling operation and other causes (9.5%). However, in the later part of this study, the main causes became gynecological (57%) with obstetric causes contributing in only 43% of the cases. Urinary fistulae still represent a major problem in Syria and reflect a sub-optimal level of training of undergraduate and post-graduate students and poor socio-economic conditions. The overall cure rate was 77%. It is hoped that with better hospital care, improvement in the quality of medical practice and the socio-economic status in the country, the incidence of genito-urinary fistulae will be reduced.