Transvaginal mobilization and utilization of the anterior bladder wall to repair vesicovaginal fistulas involving the urethra

Elkins, Thomas E.; Ghosh, T.S.; Tagoe, G. A.; Stocker, Rob

doi:10.1097/00006250-199203000-00026

Cited by 49 publications

(18 citation statements)

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“…10 It also correlate with other studies where they have shown that primipara are more vulnerable to develop fistula 6,11,13 .…”

Section: Resultsupporting

confidence: 75%

Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh

Begum¹

2012

J. Bangladesh Coll. Phys.

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Genitourinary fistula is one of the most dreadful complications encountered in obstetrics and gynaecology and constitute a major surgical challenge for the urogynecologist. With advanced obstetric care, this fistula is rare in industrialized world but it is still a major health problem in underdeveloped countries, particularly in sub- Saharan Africa and Asia including Bangladesh. Victim of fistula become physically cripple, socially outcast, psychologically traumatized. Surgical repair is the definitive cure. A surgeon with adequate training and experience can optimize outcome of surgery by modifying techniques. Repair of vesicovaginal fistula remains a major challenge to surgeon worldwide. Aim of the study was to undertake a baseline evaluation of all genitourinary fistula cases and to share the experience of management of fistula with others. This descriptive study was conducted in the department of Obstetrics and Gynaecology, Sylhet M.A.G. Osmani MedicalCollege Hospital. A total 311 genitourinary fistula cases were admitted and managed here from July 2004 to March 2010. In this study 64.63% of the patients were between 20-35yrs of age (range 18-70yrs), 42.76% were primipara whereas 20.57% were grandmulti. Height was <145cm in 67.84% cases. Majority (80.38%) of the patients were from poor socioeconomic status; 91.63% was housewife, and 89.38% was illiterate. Obstructed labour was responsible for 86.81% of fistula. Vesico-vaginal fistula was the most common (87.46%) type of fistula and 79.43% of fistula was complex in nature. 92.10% had local repair through vaginal approach, labial fat graft was used in 44% cases. In this study out of 242 operation 85.54 %(n-207) had successful repair. Among them 75.61% patient were completely continent. Causes of failure were likely to be due to extensive scarring with loss of tissue, previous failed repair, large size of fistula and in some cases post-operative catheter problem and infection. Fistula is largely a preventable condition. More emphasis should be given on prevention of fistula by increasing community awareness, female education and empowerment, avoiding early marriage, family planning, improved maternity services, timely referral and availability of emergency obstetric care services. DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11328 J Bangladesh Coll Phys Surg 2011; 29: 207-212

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“…10 It also correlate with other studies where they have shown that primipara are more vulnerable to develop fistula 6,11,13 .…”

Section: Resultsupporting

confidence: 75%

Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh

Begum¹

2012

J. Bangladesh Coll. Phys.

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“…3. Initial success was noted with a Tanagho-like anterior bladder flap to reform a urethra when total urethral slough had resulted from vaginal outlet obstruction in labor [45]. Training programs for senior-level gynecology residents were devised, and pilot programs have taken place in both Ghana and Nigeria, resulting in a new generation of surgeons to address the fistula problem in these areas [46].…”

Section: The 'Para-leak' Period (1980-2000)mentioning

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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“…Whistle tip stents were placed vaginally through the fistula tract and brought out through the remnant of the urethral meatus to avoid obstruction of the operative field. described by Elkins et al [8]. The edges of the fistula tract were identified and the bladder mucosa was separated from the vaginal tissue by undermining with Thorek scissors.…”

Section: Case #2: Primary Fistula With Traumatic Amputation Of Proximmentioning

confidence: 99%

Surgical Approach to Obstetric Fistula Repair in Niamey, Niger: A Description of Surgical Technique

Erekson

Hampton²,

Idrissa³

et al. 2011

Gynecol Obstetric

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Objective: The objective of this project is to describe the diagnostic and surgical techniques utilized for the repair of complex obstetric vesico-vaginal fistula.Cases: The two cases described include a recurrent pinpoint fistula at the bladder neck and a primary fistula with traumatic amputation of the proximal urethra.Comment: Although most surgeons are unlikely to encounter the complexity of fistula caused by obstructed labor, principles used in the diagnosis and treatment of the complicated obstetric fistulas can guide surgeon approaching vesico-vaginal fistula repair of any etiology.

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Transvaginal mobilization and utilization of the anterior bladder wall to repair vesicovaginal fistulas involving the urethra

Cited by 49 publications

References 0 publications

Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh

Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh

Fistula surgery: Past, present and future directions

Surgical Approach to Obstetric Fistula Repair in Niamey, Niger: A Description of Surgical Technique

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Transvaginal mobilization and utilization of the anterior bladder wall to repair vesicovaginal fistulas involving the urethra

Cited by 49 publications

References 0 publications

Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh

Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh

Fistula surgery: Past, present and future directions

Surgical Approach to Obstetric Fistula Repair in Niamey, Niger: A Description of Surgical Technique

Contact Info

Product

Resources

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Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh

Genitourinary Fistula Experience in a Peripheral Hospital of Bangladesh