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Zeleke LB, Welsh A, Abeje G, Khejahei M. Proportions and determinants of successful surgical repair of obstetric fistula in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0303020. [PMID: 38722847 PMCID: PMC11081269 DOI: 10.1371/journal.pone.0303020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Obstetric fistula is a serious and debilitating problem resulting from tissue necrosis on the reproductive and urinary and/or lower gastrointestinal tract organs due to prolonged labor. Primary studies of the treatment of obstetric fistulae report significantly variable treatment outcomes following surgical repair. However, no systematic review and meta-analysis has yet estimated the pooled proportion and identified the determinants of successful obstetric fistula surgical repair. OBJECTIVE To estimate the proportion and identify the determinants of successful surgical repair of obstetric fistulae in low- and middle-income countries. METHODS The protocol was developed and registered at the International Prospective Register of Systematic Reviews (ID CRD42022323630). Searches of PubMed, Embase, CINAHL, Scopus databases, and gray literature sources were performed. All the accessed studies were selected with Covidence, and the quality of the studies was examined. Finally, the data were extracted using Excel and analyzed with R software. RESULTS This review included 79 studies out of 9337 following the screening process. The analysis reveals that 77.85% (95%CI: 75.14%; 80.56%) of surgical repairs in low and middle-income countries are successful. Women who attain primary education and above, are married, and have alive neonatal outcomes are more likely to have successful repair outcomes. In contrast, women with female genital mutilation, primiparity, a large fistula size, a fistula classification of II and above, urethral damage, vaginal scarring, a circumferential defect, multiple fistulae, prior repair and postoperative complications are less likely to have successful repair outcomes. CONCLUSION The proportion of successful surgical repairs of obstetric fistula in low and middle-income countries remains suboptimal. Hence, stakeholders and policymakers must design and implement policies promoting women's education. In addition, fistula care providers need to reach and manage obstetric fistula cases early before complications, like vaginal fibrosis, occur.
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Affiliation(s)
- Liknaw Bewket Zeleke
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
| | - Alec Welsh
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
| | - Gedefaw Abeje
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marjan Khejahei
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
- Women’s and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Western Sydney University, Sydney, Australia
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Maroyi R, Shahid U, Vangaveti V, Rane A, Mukwege D. Obstetric vesico-vaginal fistulas: Midvaginal and juxtacervical fistula repair outcomes in the Democratic Republic of Congo. Int J Gynaecol Obstet 2021; 153:294-299. [PMID: 33164206 DOI: 10.1002/ijgo.13472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to establish the postoperative success rates of midvaginal versus juxtacervical obstetric vesicovaginal fistula (VVF) repairs. In addition, we aim to quantify the impact of patient sociodemographic variables, fistula classification, and surgical repair techniques associated with postoperative outcomes. METHODS A retrospective cohort study was conducted involving 420 women who had undergone a primary obstetric VVF repair. All data were collected from the Panzi Hospital, Democratic Republic of Congo between 2015 and 2017. Patient notes were analyzed to determine sociodemographic variables, symptoms, fistula classification, surgical repair techniques, and postoperative follow up. Binary logistic regression presented as χ2 for trend was used to establish P values. RESULTS Overall, 95.6% and 96.2% of midvaginal and juxtacervical VVF, respectively, underwent a successful repair. The principal prognostic factor associated with a statistically significant likelihood of a successful repair was the degree of fibrosis noted preoperatively (P =0.004, 95% confidence interval [CI] 2.38-94.61). Furthermore, VVF were more likely to have a successful repair if they were closed in two layers (P = 0.004, 95% CI 1.86-25.81) and sutured vertically (P = 0.005, 95% CI 1.16-2.52). CONCLUSION Overall, high postoperative success rates of obstetric VVF repair can be expected among well-trained surgeons but a complex interplay of factors means that the ability to preoperatively foreshadow individual outcomes remains difficult.
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Affiliation(s)
- Raha Maroyi
- Department of Obstetrics and Gynecology, Panzi General Referral Hospital, Université Evangelique en Afrique (UEA), Bukavu, The Democratic Republic of Congo
| | - Usama Shahid
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Venkat Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Ajay Rane
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Denis Mukwege
- Department of Obstetrics and Gynecology, Panzi General Referral Hospital, Université Evangelique en Afrique (UEA), Bukavu, The Democratic Republic of Congo
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Yan D, Shi Z, Wang L, Zhao X. Migration of a fractured ring IUD resulting in vesicovaginal fistula and vaginal calculus. EUR J CONTRACEP REPR 2018; 23:387-389. [PMID: 30324812 DOI: 10.1080/13625187.2018.1517409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
CASE Although many complications have been reported with intrauterine contraceptive devices (IUDs), vesicovaginal fistula with secondary vaginal stones is rare. We report the case of a 46-year-old woman who presented with a vaginal discharge lasting 2 months. Two years previously, she had undergone cystoscopic lithotripsy and surgery to remove an IUD, after pelvic radiography had revealed a fractured Chinese stainless steel ring IUD with secondary vesical stones that had been the cause of her urinary tract symptoms. When she again complained of vaginal discharge, vaginal stones and a vesicovaginal fistula were found on physical examination and CT urography. The patient underwent stone removal and concurrent vesicovaginal fistula repair. IUD fragments were found in the vesicovaginal and rectovaginal spaces. No abnormalities were found at follow-up 6 months after surgery. CONCLUSION In any woman undergoing surgery to remove a migrated IUD, complete exposure and removal of the IUD are necessary to avoid fracturing of the IUD, secondary breakage and residue.
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Affiliation(s)
- Dewen Yan
- a Department of Gynaecology , Taizhou First People's Hospital , Taizhou , China
| | - Zhan Shi
- b Department of Urology , Taizhou First People's Hospital , Taizhou , China
| | - Liping Wang
- a Department of Gynaecology , Taizhou First People's Hospital , Taizhou , China
| | - Xiumin Zhao
- a Department of Gynaecology , Taizhou First People's Hospital , Taizhou , China
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Shephard SN, Lengmang SJ, Kirschner CV. Bladder stones in vesicovaginal fistula: is concurrent repair an option? Experience with 87 patients. Int Urogynecol J 2016; 28:569-574. [PMID: 27640063 DOI: 10.1007/s00192-016-3142-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess the outcomes of a one-stage approach to bladder stones in the setting of a vesicovaginal fistula, performing fistula repair concurrently with stone extraction. METHODS Retrospective review of urogenital fistula surgeries at Evangel VVF Center in Jos, Nigeria, between December 2003 and April 2014, identified 87 women with bladder stones accompanying their fistulas and 2,979 repaired without stones. Concurrent stone extraction and fistula repair were performed in 51 patients. Outcomes were compared with respect to fistula size, classification, and fibrosis. RESULTS Women presenting with bladder stones were older and had larger fistulas than those without stones (P < 0.001). Additionally, their fistulas were more often classifiable as large and less often as high (P = 0.02), and were more fibrotic (P = 0.003). Twenty-six (51 %) patients with concurrent repair successfully became dry. Comparing results by classification, concurrent repair of high fistulas with stones was very likely to be successful (OR 8.8, 95% CI 1.0-78.2), whereas low fistulas were not (OR 0.2, 95% CI 0.02-0.7). Outcomes were similar to those of patients without stones, except for low fistulas, which were 5 times more likely to fail (P = 0.04). CONCLUSION Concurrent closure of vesicovaginal fistula at the time of bladder stone extraction is possible and, in many respects, preferable to a staged approach, particularly among high or midvaginal fistulas.
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Affiliation(s)
- Steven N Shephard
- Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria.
| | - Sunday J Lengmang
- Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria
| | - Carolyn V Kirschner
- Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria
- NorthShore University HealthSystem, Evanston, IL, USA
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Hillary CJ, Osman NI, Hilton P, Chapple CR. The Aetiology, Treatment, and Outcome of Urogenital Fistulae Managed in Well- and Low-resourced Countries: A Systematic Review. Eur Urol 2016; 70:478-92. [PMID: 26922407 DOI: 10.1016/j.eururo.2016.02.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Urogenital fistula is a global healthcare problem, predominantly associated with obstetric complications in low-resourced countries and iatrogenic injury in well-resourced countries. Currently, the published evidence is of relatively low quality, mainly consisting retrospective case series. OBJECTIVE We evaluated the available evidence for aetiology, intervention, and outcomes of urogenital fistulae worldwide. EVIDENCE ACQUISITION We performed a systematic review of the PubMed and Scopus databases, classifying the evidence for fistula aetiology, repair techniques, and outcomes of surgery. Comparisons were made between fistulae treated in well-resourced countries and those in low-resourced countries. EVIDENCE SYNTHESIS Over a 35-yr period, 49 articles were identified using our search criteria, which were included in the qualitative analysis. In well-resourced countries, 1710/2055 (83.2%) of fistulae occurred following surgery, whereas in low-resourced countries, 9902/10398 (95.2%) were associated with childbirth. Spontaneous closure can occur in up to 15% of cases using catheter drainage and conservative approaches are more likely to be successful for nonradiotherapy fistulae. Of patients undergoing repairs in well-resourced countries, the median overall closure rate was 94.6%, while in low-resourced countries, this was 87.0%. Closure was significantly more likely to be achieved using a transvaginal approach then a transabdominal technique (90.8% success vs 83.9%, Fisher's exact test; p=0.0176). CONCLUSIONS It is difficult to conclude whether any specific route of surgery has advantage over any other, given the selection of patients to a particular procedure is based upon individual fistula characteristics. However, surgical repair should be carried out by experienced fistula surgeons, well versed in all techniques as the primary attempt at repair is likely to be the most successful. PATIENT SUMMARY Urogenital fistulae are a common problem worldwide; however, the available evidence on fistula management is poor in quality. We searched the current literature and identified that 95% of fistulae occur following childbirth in low-resourced countries, whereas 80% of fistulae are associated with surgery in well-resourced countries, where successful repair is also more likely to be achieved. The first attempt at repair is often the most successful and therefore fistula surgery should be centralised to hospitals with the most experience.
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Affiliation(s)
| | - Nadir I Osman
- Academic Urology Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Hilton
- Department of Urogynaecology, Newcastle University, Newcastle, UK
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Khisa W, Wakasiaka S, McGowan L, Campbell M, Lavender T. Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya. BJOG 2016; 124:503-510. [PMID: 26892879 DOI: 10.1111/1471-0528.13902] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To gain understanding of the first-hand experience of women prior to and following repair of a vaginal fistula, to determine the most effective support mechanisms. DESIGN Qualitative phenomenological study using a series of in-depth semi-structured interviews at two time points: prior to fistula repair and 6 months post-surgery. Data were analysed thematically. SETTING Three fistula clinics in three districts in Kenya. POPULATION A purposive sample of 16 women suffering with vaginal fistula who were seeking fistula repair. METHODS Thrity-two semi-structured interviews were conducted. RESULTS The two main themes represented the women's journeys from social isolation to social reintegration. Women felt euphoric following fistula repair, believing that a 'miracle' had occurred. However, the 'post-miracle phase' demonstrated that the social and psychological impact of fistula leaves scars that are not easily healed, even when fistula repair is successful. CONCLUSION Women's experiences of living with fistula have an impact beyond that which can be repaired solely by surgery. The findings from this study support the need for more active psychological assessment in the management of women with fistula, and the role of targeted psychological support in any package of care given in the post repair phase. The format of this support requires further study. Engagement by health professionals with the wider community could raise awareness of the causes of fistula, and provide support for significant others who may also be feeling vulnerable. It is likely that the collaborative efforts from health professionals and community members will provide the most effective support. TWEETABLE ABSTRACT Fistula surgery alone is insufficient for women's physical, social and psychological recovery.
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Affiliation(s)
- W Khisa
- Department of Obs/Gynae, Kenyatta National Hospital, Nairobi, Kenya.,School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - S Wakasiaka
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - L McGowan
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M Campbell
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - T Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Tebeu PM, Fokom-Domgue J, Kengne Fosso G, Tjek Biyaga P, Nelson Fomulu J, Rochat CH. Étude comparative du résultat de la cure des fistules vésico-vaginales avec et sans interposition du lambeau de Martius : une expérience camerounaise. Prog Urol 2015; 25:1225-31. [DOI: 10.1016/j.purol.2015.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
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Jokhio AH, Rizvi RM, Rizvi J, MacArthur C. Prevalence of obstetric fistula: a population-based study in rural Pakistan. BJOG 2014; 121:1039-46. [DOI: 10.1111/1471-0528.12739] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- AH Jokhio
- Department of Obstetrics and Gynaecology; Aga Khan University; Karachi Pakistan
| | - RM Rizvi
- Department of Obstetrics and Gynaecology; Aga Khan University; Karachi Pakistan
| | - J Rizvi
- Department of Obstetrics and Gynaecology; Aga Khan University; Karachi Pakistan
| | - C MacArthur
- School of Health and Population Sciences; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
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Tebeu PM, Fomulu JN, Khaddaj S, de Bernis L, Delvaux T, Rochat CH. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J 2012; 23:387-94. [PMID: 22143450 PMCID: PMC3305871 DOI: 10.1007/s00192-011-1622-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 11/17/2011] [Indexed: 01/15/2023]
Abstract
Obstetric fistula is the presence of a hole between a woman's genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. We conducted a search of the literature to identify all relevant articles published during the period from 1987-2008. Among the 19 selected studies, 15 were reports from sub-Saharan Africa and 4 from the Middle East. Among the reported fistula cases, 79.4% to 100% were obstetrical while the remaining cases were from other causes. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of cases, and combined vesicovaginal and rectovaginal fistulae were reported in 1% to 23% of cases. Teenagers accounted for 8.9% to 86% of the obstetrical fistulae patients at the time of treatment. Thirty-one to 67% of these women were primiparas. Among the obstetric fistula patients, 57.6% to 94.8% of women labor at home and are secondarily transferred to health facilities. Nine to 84% percent of these women delivered at home. Many of the fistula patients were shorter than 150 cm tall (40-79.4%). The mean duration of labor among the fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of patients labored for more than 24 h. Operative delivery was eventually performed in 11% to 60% of cases. Obstetric fistula was associated with several risk factors, and they appear to be preventable. This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level.
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Affiliation(s)
- Pierre Marie Tebeu
- Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme, Yaoundé, Cameroon.
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Obstetric fistula: the ECWA Evangel VVF Center surgical experience from Jos, Nigeria. Int Urogynecol J 2010; 21:1525-33. [PMID: 20700729 DOI: 10.1007/s00192-010-1231-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 07/16/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objectives of this study are to analyze the surgical outcomes of women undergoing obstetric fistula repair operations at the ECWA Evangel VVF Center, Jos, Nigeria, and to identify factors associated with postoperative urinary continence. METHODS Sociodemographic and clinical data were abstracted retrospectively from the Center's database for patients who underwent vesicovaginal fistula (VVF) repair operations. These data were compared with clinical outcome ("wet" or "dry") at the time of hospital discharge. RESULTS From August 1998 to April 2004, 1,084 fistula repair operations were performed on 926 patients. A vaginal approach was used in 90.1% of cases, and postsurgical continence was achieved in 70.5% of patients. Continence was more likely in patients with an intact urethra, an upper or midvaginal fistula, and less fibrosis than in those patients who remained wet. CONCLUSIONS Two thirds of patients with obstetric fistulas can be cured, with complete restoration of continence and low surgical morbidity, using a transvaginal surgical approach.
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Fiadjoe P, Kannan K, Rane A. Maternal urological problems in pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 152:13-7. [PMID: 20483528 DOI: 10.1016/j.ejogrb.2010.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/05/2010] [Accepted: 04/26/2010] [Indexed: 11/29/2022]
Abstract
Urological conditions in pregnancy represent a major diagnostic and therapeutic challenge. During pregnancy the urinary tract undergoes some anatomical and physiological changes that may result in many symptoms and pathological conditions affecting both the mother and fetus. With prompt evaluation and expeditious treatment, the prognosis is good. Fear of causing harm is unfounded. This article describes urological problems in pregnancy, specifically infection, calculus, renal failure, renal tumour, lower urinary tract symptoms and trauma and their management.
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Affiliation(s)
- Paul Fiadjoe
- Department of Urogynaecology, The Townsville Hospital, Angus Smith Drive Douglas, Townsville, QLD 4814, Australia.
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Tebeu PM, de Bernis L, Doh AS, Rochat CH, Delvaux T. Risk factors for obstetric fistula in the Far North Province of Cameroon. Int J Gynaecol Obstet 2009; 107:12-5. [PMID: 19589525 DOI: 10.1016/j.ijgo.2009.05.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/25/2009] [Accepted: 05/19/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the circumstances of occurrence and identify potential risk factors for obstetric fistula in northern Cameroon. METHODS A case series study of 42 obstetric fistula patients seeking services at the Provincial Hospital of Maroua, Cameroon, between May 2005 and August 2007. Structured interviews were conducted prior to surgical intervention. RESULTS Among obstetric fistula patients, 60% had lived with obstetric fistula for more than 5 years at the time of surgery. Eighty-one percent of patients had received no formal education and 86% were teenagers at their first delivery. Regarding the pregnancy and delivery preceding the occurrence of the fistula, 50% of women reported that they had received no prenatal care and 76% were in labor for more than 12 hours. The majority (83%) of women delivered a stillborn baby. CONCLUSIONS Obstetric fistula patients in the Far North Province of Cameroon had a low level of education, were married at a young age, and had poor access to quality maternal healthcare services.
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Affiliation(s)
- Pierre Marie Tebeu
- Department of Obstetrics and Gynecology, Provincial Hospital, Maroua, Cameroon.
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Abstract
PURPOSE OF REVIEW Urethrovaginal fistulae are a rare condition. It is a conceptual mistake to consider urethrovaginal fistulae to be synonymous with vesicovaginal fistulae. Urethrovaginal fistulae are a different entity requiring special attention and treatment. Due to the wide variety and individuality of the clinical manifestations of these injuries, it is practically impossible to find and create common guidelines for treatment. Taking into account the difficulty of urethrovaginal fistula treatment, we decided to conduct a review of the current literature on this subject. RECENT FINDINGS Due to advances in obstetric care, urologists in the developed world encounter urethrovaginal fistulae rarely, and many of the fistulae seen are secondary to vaginal surgery. Surgical treatment procedures include direct primary anatomical repair and interpositional tissue restorations, mainly by Martius flap. Successful direct anatomical repair alone may result in the development of stress urinary incontinence or obstructed voiding in up to 50% of patients. Synthetic tape should be removed during fistula repair, which may lead to the resumption of stress incontinence. SUMMARY Prevention of urethrovaginal fistulae can be achieved through both improvements in obstetric care and adequate training in vaginal surgery. The success of any surgical treatment depends on careful patient selection, and assumes knowledge of all possible treatment options. Potential work needs to be directed towards the application of the newest molecular technologies.
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Tsui AO, Creanga AA, Ahmed S. The role of delayed childbearing in the prevention of obstetric fistulas. Int J Gynaecol Obstet 2007; 99 Suppl 1:S98-107. [PMID: 17868676 DOI: 10.1016/j.ijgo.2007.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the role of delayed childbearing in the prevention of obstetric fistulas (OFs). METHODS Data on 4798 deliveries in Niger (1995-1998), 3552 in Nigeria (1996-1999), and 6789 in Tanzania (1991-1996) were analyzed with logistic regression models. RESULTS Young maternal age and primiparous status were identified as correlates of prolonged/obstructed labor. The annual incidence of OFs in Nigeria was found to be 2.11 per 1000 births, with 9817 cases developing each year, 28% in women and girls younger than 20 years. The predicted proportion of women experiencing prolonged/obstructed labor would be reduced by 11.2% in Niger, 11.4% in Nigeria, and 13.1% in Tanzania if the risks associated with young maternal age at first delivery and primiparity were eliminated. CONCLUSIONS Community programs to educate young, newly married women about delaying childbearing until they reach physical maturity should be implemented in countries with a high incidence of OFs.
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Affiliation(s)
- A O Tsui
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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15
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Abstract
A high proportion of genitourinary fistulas have an obstetric origin. Obstetric fistulas are caused by prolonged obstructed labor coupled with a lack of medical attention. While successful management with prolonged bladder drainage has occasionally been reported, mature fistulas require formal operative repair, and it is crucial that the first repair is done properly. The literature reports 3 approaches to fistula repair: vaginal, abdominal, and combined vaginal and abdominal. Many authors report high success rates for the surgical closure of obstetric fistulas at the time of hospital discharge, without further evaluation of the repair's effect on urinary continence or subsequent quality of life. Data on obstetric fistulas are scarce, and thus many questions regarding fistula management remain unanswered. A standardized terminology and classification, as well as a data reporting system on the surgical management of obstetric fistulas and its outcomes, are critical steps that need to be taken immediately.
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Affiliation(s)
- A A Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Nafiou I, Idrissa A, Ghaïchatou AK, Roenneburg ML, Wheeless CR, Genadry RR. Obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. Int J Gynaecol Obstet 2007; 99 Suppl 1:S71-4. [PMID: 17727853 DOI: 10.1016/j.ijgo.2007.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the epidemiologic and therapeutic characteristics of obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. METHODS From December 2003 to February 2005, 111 consecutive patients with vesico-vaginal fistulas presenting for treatment were included and prospectively followed up. Demographic and clinical data were collected. The patients were re-evaluated 3 months after surgery. RESULTS Among the 104 patients treated surgically 87% were aged between 15 and 36 years; 84% were married before they were 19 years old; 51% were divorced; and 80% did not live with their husbands. The fistula was caused by the first delivery in 43% of the patients; 93% were in labor for more than 24 hours; 35% were delivered at home; and perinatal death was 100%. The overall cure rate was 73%. CONCLUSION These epidemiologic characteristics provide data towards the development of an obstetric fistula prevention program in Niger.
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Affiliation(s)
- I Nafiou
- University of Niamey, Niamey, Niger
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