Personal experiences in the treatment of vesicovaginal fistulas

Moir, J. Chassar

doi:10.1016/0002-9378(56)90476-8

Cited by 48 publications

(21 citation statements)

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“…The older knee-chest position had been modified to a reverse lithotomy or Lawson position [15]. Others, like Miller from Michigan, chose to use an exaggerated Trendelenburg tilt with lithotomy [13].…”

Section: The Sims Surgical Methodsmentioning

confidence: 99%

Fistula surgery: Past, present and future directions

Elkins

1997

Int Urogynecol J

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This text is about fistulas, but it cannot help but become much more. It is also a discussion of the foundational development of gynecologic pelvic floor surgery and the innovations and motivations in our field, throughout history.Reflections on genital tract fistulas in women take us back to the beginnings of written history itself. Such reflections also unite the problem of (urinary) incontinence with that of pelvic organ prolapse, since these were the two common gynecologic problems of women noted in the Kahun papyri of ancient Egypt (--2000 BC), perhaps the earliest written 'medical' text [1].To understand the history of genitourinary fistulas and subsequent pelvic surgery, it has been helpful to return to rural West Africa, where such findings are still common. Over 35 trips, spanning nearly 4 of the past 21 years, have resulted in many of the insights presented in this discussion. In rural Africa true obstructed labor is common because of early childbearing, an inherited anthropoid/android pelvis with marked lumbar lordosis, and a lack of medical care. The absence of modern healthcare systems results in a reliance upon traditional healthcare customs and treatments that often delay or prevent access to contemporary obstetric care when it is available. The general lack of effective family planning also contributes to the problem. When appropriate care for a laboring patient is finally sought, the lack of transportation, roads and communication systems often make such efforts futile. The result has been a mortality ratio of 6-10 maternal deaths per 1000 deliveries in major medical centers in West Africa, and an average of Correspondence and offprint requests to:

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Section: The Sims Surgical Methodsmentioning

confidence: 99%

Fistula surgery: Past, present and future directions

Elkins

1997

Int Urogynecol J

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“…The urologic literature predominantly describes a transvesical approach, 28 -32 whereas the gynecologic literature describes a transvaginal approach. 4,8,10 The argument for transvaginal repair in the case of "simple" postoperative vesicovaginal fistula is strong. Success rates using the transvaginal Latzko repair exceed 90% and are associated with minimal morbidity.…”

Section: Operative Approach Of Vesicovaginal Fistula Repairmentioning

confidence: 99%

“…The review that follows cannot do justice to the rich history of fistula repair, [3][4][5] but instead focuses on the modern approach to genitourinary fistulas, including etiology, diagnosis, operative procedures, and medicolegal issues.…”

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confidence: 99%

Modern Management of Genitourinary Fistula

Kenton

Brubaker

2005

Journal of Pelvic Medicine and Surgery

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Key Words: vesicovaginal fistulas, bladder fistulas, urinary fistulas, vaginal fistulas, surgical flaps, labor complications (J Pelvic Med Surg 2005;11:223-234) A review of the historic and world literature on urogenital fistula in women leaves one with 2 powerful realizations; the first is the remarkable suffering and enduring strength of women who are afflicted with urogenital fistulas, and the second is the ingenuity and the perseverance of the surgeons who have made this their life's work. In countries with modern obstetric care, most genitourinary fistulas form after gynecologic or urologic surgery. However, in nations without well-developed obstetric care, one to 2 of 1000 women experience genitourinary fistula as a complication from obstructed labor. 1 In Nigeria alone, almost 20,000 women with fistula await repair. Most of these women are young, illiterate, and become social outcasts after being abandoned by their husbands.J. Marion Sims' surgical innovations changed the lives of patients with fistulas worldwide when he reported the first series of successful fistula closures in 1852. Although his work has been criticized using modern ethical paradigms, 2 many of his surgical principles remain the foundation for fistula repair today. Since that time, genitourinary fistula repair has been "a history of skillful surgeons, influencing each other over time . . . in which change came, though often slowly." 3 Currently, the successful closure rate for primary vesicovaginal fistula repair is greater than 90% in the hands of specialized surgeons.The review that follows cannot do justice to the rich history of fistula repair, 3-5 but instead focuses on the modern approach to genitourinary fistulas, including etiology, diagnosis, operative procedures, and medicolegal issues. ETIOLOGY OF GENITOURINARY FISTULASWhen obstetric care is not available, obstructed labor goes untreated, often resulting in genitourinary fistulas. The risk of fistula is further increased when the lack of medical care is compounded with early childbearing when a woman's pelvis is immature. 3 In an epidemiologic study from 1983 to 1988 of vesicovaginal fistula in Ethiopia, Kelly found that 97% of the vesicovaginal fistulas had an obstetric cause. 6 The majority of women affected were primigravidas who had unassisted vaginal delivery that lasted for a mean of 3.9 days. This tragedy is especially heartbreaking because the majority of women who experience obstetric vesicovaginal fistula do not have a live baby, with stillbirths occurring in 93% of the fistula-inducing deliveries. He also reported a high rate of concomitant injuries (probably neuromuscular) such that the mean time before a patient could walk again was 26 days.Obstetric vesicovaginal fistulas are associated with tissue necrosis and significant tissue loss. Waaldijk 1 characterized 1716 women with genitourinary fistulas who presented to a Nigerian fistula hospital during a 9-year period. Sixty percent of patients had fistulas Ն2 cm and 22% Ն6 cm. The majority (85%) involved

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“…(1) The technic we commonly use is the Chassar-Moir [3,4] pro cedure, which is not very different from Sim's basic technic. The patient is placed in the lithotomy position and exposure is improved by stitching the two labia majora and by lowering the head of the table.…”

Section: Technicsmentioning

confidence: 99%