17 17 NJOG / VOL 9 / NO. 1 / ISSUE 17/ Jan-Jun, 2014 Aim: The study was done to review the demography of urogenital istulae including obstetric istula (OF) and its surgical outcome in the early phase of istula surgery and to create awareness about OF. Methods: This was a retrospective study of 47 patients who underwent istula surgery during the period of January 2012 to May 2014 in Kathmandu Model Hospital, Helping Hand Community Hospital, Camp in Mid-wetern Regional Hospital Surkhet and Hamlin Hospital, Ethiopia. The primary outcome was in terms of urinary continence after 14 days of repair. Results: In the study 70% (n=33) of istula were due to obstructed labour and 30% (n=14) were due to hysterectomy for gynecological indications. Ninety six percent (n=45) had successful closure of istula. Seventy seven percent (n=36) were continent after surgery, and 17% (n=8) had some stress incontinence. Conclusions: The study showed obstructed labour was the major cause of OF, however iatrogenic istula was also becoming common. The success of repair depended on the type, site, size of istula and urethral length. Majority of our cases had successful closure of istula with some degree of stress in some patients. Keywords: istula repair, obstructed labour, obstetric istula, vesicovaginal istula. Experience of Managing Urogenital Fistula Pradhan HK, Dangal G, Karki A, Shrestha R, Bhattachan K Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Exhibition Road, Kathmandu. CORRESPONDENCE Dr Hema Kumari Pradhan Department of Obstetrics and Gynaecolgy, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal. Email: drhemapradhan@hotmail.com Phone: +977-9849375252 INTRODUCTION Genital istula is a tragedy of developing world because of illiteracy, poverty, ignorance and lack of health facilities. Obstetric istula is an abnormal hole between the vagina and the urinary bladder (VVF) or vagina and rectum (RVF) resulting in urinary incontinence or fecal incontinence caused by unrelieved obstructed labor. Prolonged pressure of the baby’s head against the back of the pubic bone produces ischemic necrosis of the intervening soft tissue. The extent of injury depends on the duration of labor. In most severe cases, ischemia affects the whole of anterior wall of vagina, bladder base, much of urethra and sometimes the rectum. 1 Obstetric istula is a disease of developing world whereas in developed world it occurs after hysterectomy and other gynaecological surgeries. It is estimated that there are at least two million women living with istula primarily in sub- Sahara Africa and South Asia and some 50,000-100,000 women are affected each year. 2, 3 The women who survive with OF suffer from devastating conditions like damaged cervix, neurological condition like foot drop, leakage of urine and/ or faeces, ammonical dermatitis, social isolation and they are abandoned by family and husband. Women suffer for years as treatment services are rare and even when available they lack the knowledge that istula can be repaired and or they lack resources for treatment. 3 Thousands of Nepalese women silently suffer from OF. It is estimated that 200- 400 new cases of OF occur each year in Nepal. 4 METHODS This study was conducted from January 2012 to May 2014 in Kathmandu Model Hospital, OF istula camp in Surkhet in Mid-western Regional Hospital, NJOG 2014 Jan-Jun; 17 (1):17-20 Orginal Article