KARACHI: Health experts have expressed concern over the rapid increase in cases of iatrogenic genital tract fistula — an abnormal connection between the urinary bladder or ureter and the vagina, created accidentally by a surgeon during an operation — in the country and called for action against healthcare providers and compensation for the affected female patients.

They said this at a press conference jointly organised by the Pakistan National Forum on Women’s Health, the Pakistan Medical Association, and the Society of Surgeons Pakistan, at the PMA House.

“While the cases of obstetric fistula in Pakistan are declining, the cases of iatrogenic fistula have increased dramatically in recent years,” said senior gynaecologist Dr Shershah Syed.

He added that around 600 cases of iatrogenic fistula were repaired at a single hospital in Karachi last year.

Demand patients be compensated when a doctor is responsible for an injury during surgery

He recalled that these cases included at least 17 patients who had been operated on by an anaesthetist.

This type of fistula, he explained, occurs when poorly trained surgeons perform major operations such as abdominal hysterectomy and lower uterine segment caesarean sections.

“In Pakistan, it’s common for qualified doctors without any surgical training to perform these procedures. Then, there are general surgeons, urologists, orthopaedic surgeons, unsupervised postgraduate trainees, and even neurosurgeons conducting medical procedures that fall within the domain of obstetrician-gynaecologists (OBGYNs),” he elaborated.

He also noted that quacks and traditional birth attendants are performing surgeries, contributing to the rise in iatrogenic fistula cases.

Dr Shershah expressed surprise that “for some strange reason”, the College of Physicians and Surgeons of Pakistan had allowed OBGYN trainees to pursue courses in ultrasound/radiology instead of urology or general surgery.

Dr Abdul Ghafoor Shoro pointed out that few postgraduate centres in Pakistan provide structured training to postgraduate trainees. “This system forces candidates to take shortcuts, obtain postgraduate diplomas, and start working as consultants. They are more likely to make blunders, cutting the uterus left and right and causing fistulas.”

The experts demanded that patients should be compensated when a surgeon is responsible for an injury during an operation.

“It’s the duty of the hospital to assist these patients and ensure their fistulas are repaired without any charge,” they said, calling upon the heads of medical colleges and universities to monitor the quality of postgraduate training.

Also present were Dr Amenda Strum and Dr Martin Verriblom, both Swedish surgeons visiting Pakistan.

They emphasised the need for adopting conservative management, stating that surgery should be the last option, and efforts should be made to keep procedures minimally invasive.

Published in Dawn, September 26th, 2024