Trends of Genitourinary Fistula in Kigali, Rwanda, over a 10-year Period.

Genitourinary (GU) fistula most commonly occurs following ischemic damage during protracted labor or iatrogenic injury at time of surgery. Many developing nations report high rates of ischemic fistula, in part due to limited healthcare access. We aimed to assess the etiology and trends of genitourinary fistula in Rwanda over a 10-year period. Retrospective chart review of women presenting for management of fistula in Kigali, Rwanda, between 2013 and 2024. Iatrogenic etiology was defined as those temporally following cesarean section or hysterectomy and included vesico-uterine, vesico-cervical, uretero-vaginal, vesico-vaginal at vaginal cuff, or high vesico-vaginal fistula. All other GU fistula were assigned as ischemic. There were 909 women diagnosed with GU fistula with 416 (46%) characterized as iatrogenic and 493 (54%) as ischemic fistula. Iatrogenic fistula had significantly higher proportions of abdominal routes for repair (40% vs 5%) and abdominal hysterectomies performed (26% vs 5%) compared to ischemic fistulas (p < 0.001). Ischemic fistula were more likely to be recommended for urinary diversion (29% vs. 4%, p < 0.001). There was a significant increase in iatrogenic fistula over time with a 2.1% increase per year (p < 0.001) (Fig. 1). There were 279 women with recurrent GU fistula with a significantly higher proportion of ischemic fistula with recurrence (p < 0.001). There was a significant increase in iatrogenic fistula over a 10-year period in Rwanda resulting from obstetrical and gynecological surgeries. Iatrogenic fistula were more likely to require a more invasive surgical approach while ischemic fistula were more likely to either be recommended for urinary diversion or present with recurrence following repair.