Objective: Vesico-vaginal fistulas (VVF's) cause enormous harm to women in developing countries. This prospective study intends to highlight epidemiological, etiological and pathological data, and to define predictors of surgical results in a national referral hospital setting. Material and Methods: All consecutive patients with VVF presenting at the Kigali Hospital Centre of Rwanda between 1997 and 2001 were included. Data on epidemiology, pathology, therapy and outcome were prospectively

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... ned. The risk factors for therapeutic failure were identified by multivariate analysis. Results: Ninety eight percent of all cases were of obstetrical origin. Twenty five percent of VVF were categorized as simple, 64% as complex and 11% as complicated. Complete closure and continence were obtained in 87 (77.7%) cases and closure with moderate incontinence in 7 cases (6.3%). In 18 cases (16%) closure failed even after 3 surgical attempts. The independent risk factors for therapeutic failure were vaginal fibrosis (p<0.001) and total destruction of the bladder neck (p=0.002). Conclusion: We conclude that failure is basically linked to the level of destruction of the bladder neck as well as the magnitude of pelvic scarring. Surgery of complex and complicated VVF remains a challenge and requires multi-skilled surgeons. The lasting solution is the development of maternity services and the training of health personnel in reproductive health.