ETIOLOGICAL SPECTRUM OF IATROGENIC UROGENITAL FISTULA IN PATIENTS PRESENTING TO TERTIARY CARE HOSPITAL

Abstract

Background: Iatrogenic urogenital fistula is a serious and preventable complication of gynecological and obstetric procedures, leading to significant physical, psychological, and social consequences. Understanding its etiological spectrum is essential for improving surgical safety and patient outcomes. Objective: To assess the etiological spectrum of iatrogenic urogenital fistula at a tertiary care hospital. Study Design: Cross-sectional observational study. Setting: Department of Obstetrics & Gynaecology, Hayatabad Medical Complex, Peshawar, Pakistan. Duration of Study: From March 2025 to September 2025. Methods: Eighty patients aged 18–45 years with a confirmed diagnosis of iatrogenic urogenital fistula were included. Data were collected using a structured pro forma that documented age, BMI, socioeconomic status, occupation, education level, and residence. The etiology of the fistula was recorded for each patient. Diagnosis was confirmed through examination under anesthesia and cystoscopy. Statistical analysis, including assessment of associations between etiology and patient characteristics, was performed using appropriate tests with a significance threshold of P < 0.05. Results: The mean age of patients was 33.08 ± 7.94 years, and the mean BMI was 24.64 ± 2.06 kg/m². Abdominal hysterectomy was the leading cause of fistula, identified in 29 cases (36.2%), followed by cesarean section in a scarred uterus in 24 cases (30.0%), hysterectomy performed for postpartum hemorrhage in 10 cases (12.5%), cesarean section in an unscarred uterus in 12 cases (15.0%), and dilatation and curettage in 5 cases (6.2%). A significant association was observed between etiology and age (P < 0.001), with abdominal hysterectomy more common in older patients and cesarean-related etiologies more common among younger women. Conclusion: Abdominal hysterectomy and cesarean section, particularly in previously scarred uteri were the most common causes of iatrogenic urogenital fistula. Abdominal hysterectomy was associated with older age, whereas cesarean-related causes were more common among younger patients. Improved surgical training and perioperative vigilance may help reduce the incidence of this preventable condition.