Vesico-vaginal fistulas in developing countries

Vesico-vaginal fistula remains a major public health issue in the developing world. Over 80% of cases result from neglected obstructed labour, and the condition may follow 1-2 per 1000 deliveries, with an annual worldwide incidence of up to 500,000 cases. The principles of investigation and treatment are reviewed in this paper, although national and international strategies aimed at prevention are much more important to the ultimate eradication of this devastating condition. Such strategies much include government recognition of fistulae as a major public health concern, improvement in the status of women in society, the extension of primary education particularly for girls, and affordable, accessible and acceptable services for all pregnant women.