The obstetric fistula: A major public health problem still unsolved

Waaldijk, Kees; Armiya'u, Y. D.

doi:10.1007/bf00376428

Cited by 54 publications

(52 citation statements)

References 4 publications

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“…Urinary incontinence following fistula repair, in particular obstetric fistula continues to be a significant problem 1,2 . A number of papers have described surgical interventions, but often with much less success than that enjoyed in women without fistulas.…”

Section: Discussionmentioning

confidence: 99%

“…One such technique is to developed a sling of pubococcygeal muscle beneath the urethra in the women with the above characteristics. 2 From a personal series of urethral fistulae, the use of this sling had reduced the incidence of urethral incontinence following repair from 55% (n = 44) to 39% (n = 272). Techniques to maintain urethral length for women with urethral injuries also require further research.…”

Section: Discussionmentioning

confidence: 99%

“…'are you leaking urine involuntarily when lying?. 2 A cough examination with a full bladder was used to confirm the diagnosis.…”

mentioning

confidence: 99%

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Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Zabin

Akhter

Sultana³

2016

Bangladesh J Obstet Gynaecol

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Introduction:Obstetric fistula surgery presents many challenges. The injury usually occurs in resource-poor areas and is thus managed in hospitals that are themselves poorly resourced. The pathology is complex and extensive, affecting any and sometimes all parts of the lower urinary tract. The long obstructed labour and resulting ischemia throughout the pelvis can destroy all the normal mechanisms for urinary continence. 1 It is one thing to be able to close the defect and try to restore normal anatomy, but it is quite another thing altogether to obtain a functional closure, ensuring normal continence. There are varied reports about the extent of incontinence after fistula surgery, from 8% 1 to more widely accepted figures of 18-33%, 2 even up to 47% in an unpublished survey performed in the Addis Ababa Fistula Hospital in 2003. As with all things, it depends on how closely a fistula surgeon look for the problem. In the early work by Kelly and Kwast, 1 the figure was the number of women returning to the hospital with continuing incontinence despite a closed fistula. It is likely that many women would have remained at home with mild incontinence. The figures of 18-33% had accepted way of looking for incontinence including a basic set of structured questions ranging from'are you wet with cough or heavy activity? 'are you leaking urine involuntarily when lying?. 2 A cough examination with a full bladder was used to confirm the diagnosis.The exact nature of the incontinence is often complex and only a handful of studies have investigated the nature of the pathology. One study 3 of 22 women with severe incontinence following fistula closure underwent urodynamic assessment: 41% had genuine stress incontinence (GSI); 14% had GSI and poor Residual urinary Incontinence after SuccessfulRepair of Obstetric Fistula

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Zabin

Akhter

Sultana³

2016

Bangladesh J Obstet Gynaecol

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“…These complications with their profound implications, impact on the psychological, financial and physical well-being of women and their families as genitourinary fistulas remain distressing and an unresolved contributor to reproductive health morbidity among women in developing countries 1 .…”

Section: Introductionmentioning

confidence: 99%

Genitourinary Fistulae Experience in a University Teaching Hospital: A South-South Nigeria Perspective

Inimgba¹,

Urogynaecology²,

John³

et al. 2018

GJMS

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Background: Genitourinary fistula is a debilitating condition affecting women globally with high incidences in developing countries. It remains an indicator of the quality of health care delivery women are offered.Objective: To present the experiences of genitourinary fistulas (GUF) at the University of Port Harcourt Teaching Hospital (UPTH), Rivers State. Methods:From January 2002 to December 2012, 104 consecutive patients with genitourinary fistulas were admitted for evaluation, treatment (surgical) and thereafter followed up. Demographic and clinical data were collected. The patients were re-evaluated 3 months after surgery.Results: Among the 67 patients treated surgically, 75% were aged between 18 and 36 years; 46 (44.2%) had vaginal repairs while 21 (20.1%) had abdominal repairs. The fistulas were caused majorly by prolonged obstructed labour (72.4%) with only 6 non obstetric causes. 37 of these patients are yet to be repaired after an initial examination under anaesthesia that was performed for every patient. These admissions do not represent or reflect the incidence of genitourinary fistulas in this centre. These characteristics provide data towards the development of an obstetric fistula prevention program in Rivers State as one presently does not exist. Conclusion:There is an increasing incidence of GUF in this environment basically due to poor obstetric care despite different strategies proposed by different studies to the government to prevent and eradicate GUF. It also demonstrates the ability of repair or cure to restore the dignity of our women if proper training and retraining of residents and specialists, funding and making health care and facilities available to these women.

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“…[2][3][4] The majority of UGFs in developed countries are a consequence of gynecological surgery, mainly hysterectomies. Other causes are iatrogenic trauma, radiotherapy, infections, malignancy etc.…”

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confidence: 99%

A case series of urogenital fistulas

et al. 2017

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Background: Urogenital fistula is an abnormal fistulous communication that occurs between the bladder and cervix or uterus; between the ureter and vagina, uterus, or cervix; and between the urethra and vagina. Most cases in developing countries are of obstetric etiology, resulting from prolonged neglected obstructed labour, and around 1–2 per 1000 deliveries may be affected. The majority of UGFs in developed countries are a consequence of gynecological surgery, mainly hysterectomies. Present study focuses on the various presentations and the different modalities of surgeries done for cases of urogenital fistulas at our institute.Methods: A total 19 cases of urogenital fistula were studied in detail as per proforma. Two patients were operated on emergency basis because of early presentation in postoperative period. For others a pre-operative waiting period of 3-6 months was followed after development of fistula. During this period initially bilateral DJ stenting was tried in all patients, in hope of spontaneous closure of fistulas. Two patients whose fistulas closed spontaneously are not subjected to surgery. Rest all cases were managed surgically by standard surgical procedures.Results: Study was conducted between, February 2015 to February 2017. A total 19 patients studied. In 2 patients, fistula healed spontaneously while in 17 patients, surgery was needed. Most common age group affected is 2nd decade of life about 47.36%. In our study gynecological surgeries predominate with 57.89% followed by obstetric cases in 26.31%. Most of patients presented with continues dribbling of urine through vagina with normal voiding pattern in about 78.94% of cases. Overall transabdominal procedures had nearly 100% success rate, mainly because of better dissection, visualization and use of vascularized graft which prevents recurrence. 1 recurrence was seen in transvesical extraperitoneal approach because of undiagnosed another fistulous tract. Ureteric reimplantation was 100% successful in ureterogenital fistulas. Vaginal approach with use of Mortius flap had 75% success rate with 1 recurrence because of flap necrosis. Mean duration of surgery was 120 minutes and mean hospital stay was 8 days..Conclusions: Urogenital fistulas are the most distressing complications of obstetric and gynecological surgeries. Obstetric causes predominate in developing countries while gynecological surgeries predominate in developed countries. Despite the good results of surgical repair, attempt should be focused on the prevention of VVF.

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The obstetric fistula: A major public health problem still unsolved

Cited by 54 publications

References 4 publications

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Genitourinary Fistulae Experience in a University Teaching Hospital: A South-South Nigeria Perspective

A case series of urogenital fistulas

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