The problem of urogenital fistula remains one of the most pressing in modern urology. The emergence of these diseases entails a significant reduction in the quality of life of these patients, which subsequently affects their social status and personal life. Despite the age of the disease, improvements in operational methods, improvement of diagnostic measures, the problem of the choice of treatment tactics and postoperative management remains relevant. Previously, the most common cause of urogenital fistula was obstetric injury. However, in recent years, surgical and post-radiation fistulas of the urogenital organs have prevailed in developed countries, while obstetric trauma remains the main cause in developing countries. Given the relevance of this problem, of great interest is the analysis of the etiological structure of urogenital fistulas at the present time. It also raises the question of the frequency and cause of the formation of certain types of fistula in different regions. As a result, epidemiological studies are of particular relevance. In addition, of particular interest is the analysis of complications arising after fistuloplasty.

We performed a prospective cross-sectional analysis among women with urogenital fistulas who applied to two clinics in different countries. For this purpose, women were selected through the electronic search system who applied to the clinic from 2012 to 2018. Their case histories were analyzed, and information about the results after the operation was collected through telephone calls or repeated examinations at the clinic.

Over the 6-year period, 254 women came to our clinic (hereinafter referred to as the first region / clinic) with the problem of urogenital fistulas, in one of the clinics of another country (hereinafter - the second region / clinic) there were 107 patients in the same period. An analysis of the data obtained revealed that the most frequent cause of fistula formation in the first region is surgery (40.5%) and the effects of previous radiation therapy (26.4%), while in the second clinic iatrogenic injury remains the main cause open surgery (85%). Preferred techniques of fistula closure are also different, in the second region transvesical fistuloplasty was performed in 71.9% of cases, and transvaginal fistuloplasty was performed in 77.7% in the first region. The average age of women was 48.85. Calculate the average age is the formula for years in both centers.

Patients differ significantly in previous attempts to fistuloplastic, namely: in the first clinic, the number of patients with a fistula correction already existing in the history was 41.3%. At the same time, in the second repeated patients account for 20.6%.
We determined that after undergoing fistuloplasty, 5.2% of women (10 people) showed signs of urinary incontinence of various types, three of them (30%) underwent surgical correction in the volume of a suburethral sling procedure at the first clinic.Revealed postoperative complications are also ureteral strictures, hydronephrosis, and bleeding. Despite the great possibilities of surgical techniques and the experience of surgeons, the number of incurable patients is significant - 6.29% (data from the 1st clinic). 11 (4.33%) women had complete destruction of the bottom of the bladder and the walls of the vagina, which required their referral to other specialized clinics.
Figure 1 shows a comparative chart for different localizations of the fistulas between our clinics (Series 1 is the first clinic; Series 2 is the second clinic).

Based on the data obtained, the prevalence of various types of fistula in two countries was revealed. Of course, our analysis has certain limitations, since we only compared data from two centers, and we can’t conduct a 100% analysis of the results of our operations due to the lack of contact information of some patients, or because of their refusal to participate in research. Despite this, our findings suggest a different etiology, epidemiology and surgical treatment techniques in patients with urogenital fistulas. After analyzing all the characteristics, we made conclusions on the basis of which it is possible to influence the frequency of fistulas.