Cytological Evaluation of Urinary Samples among Vesicovaginal Fistula Patients in National Obstetrics Fistula Centre, Southeastern Nigeria

Vesicovaginal fistula (VVF) is a non-physiological epithelial fistulous tract between the bladder and the vagina, resulting in continuous urinary incontinence. VVF occurs most commonly after obstetrical and gynecological injury. This study is a descriptive cross-sectional study designed to carry out cytological evaluation of urine samples of vesicovaginal fistula patients in National Obstetrics Fistula Centre, Southeastern Nigeria. The voided and catheterized urine samples collected were stained using Papanicolaou and Diff-Quick staining techniques. A total number of 123 patients were involved in this study. The mean age of the patients was 36.66 (± 6.21) years. The patients were grouped according to age into 4 groups: 1 (0.8%) was ≤ 24 years, 59 (48.0%) were 25 to 34 years, 43 (35.0%) were 35 to 44 years and 20 (16.2%) were ≥ 45 years of age. The parity status of these cases was grand multipara 29 (23.6%), multipara 32 (37.4%), primipara 46 (37.4%) and nullipara 16 (13.0%). Majority of the patients 111 (90.2%) were from rural areas, 8 (6.5%) from urban areas and 4 (3.3%) were from semi-urban areas. According to marital status, 91 (74.0%) were married, 16 (13.0%) were widowed, 5 (4.1%) were single and 11 (8.9%) were divorced. According to the period the patients had lived with fistula, majority of the patients 94 (76.4%) had lived less than one year with this problem, while 29 (23.6%) had suffered from VVF for 1-5 years. Cytological evaluation of the urine smears showed that a total of 92 (74.8%) urine samples had normal findings. The rest of the 31 (25.2%) urine samples showed a variety of findings. Out of these 31 samples, 16 (51.6%) showed inflammatory aggregates suggestive of urinary tract inflammation, 3 (9.7%) showed decoy cells suggestive of Polyoma virus infection, 7 (22.6%) cases showed perinuclei halo suggestive of Trichomonas vaginalis infection, 3 (9.7%) showed oval fat bodies suggestive of possible nephrotic syndrome, 8(25.8%) cases showed koilocytes, indicative of Human papilloma virus infections. Cases that showed presence of haematuria were 7 (22.6%). There was no case of tumor cells detected in all the urine samples examined. From the outcome of this study, it is important to take special note of the presence of the viral carcinogens: Polyoma virus and Human papilloma virus, since in theory and as reported in few case reports, malignancy of the urinary tract can lead to formation of vesicovaginal fistula.