Henry van Roonhuyse and the first repair of a vesico-vaginal fistula (~1676).

INTRODUCTION AND HYPOTHESIS: Obstetric vesico-vaginal fistula is a traumatic complication of prolonged obstructed labor in which pressure necrosis from the impacted fetal head destroys portions of the vesico-vaginal septum, resulting in continuous and uncontrollable urinary incontinence. Ancient evidence suggests that fistula cases have probably been occurring since the development of rotational delivery mechanics in anatomically modern humans hundreds of thousands of years ago. It is likely that attempts to repair such injuries also have a long history. The early history of vesico-vaginal fistula surgery was investigated to determine the earliest credible report of successful cure of this condition. METHODS: Historical review of vesico-vaginal fistula surgery was undertaken, focusing on the work of Henry Van Roonhuyse, a seventeenth century Dutch surgeon living in Amsterdam. RESULTS: Van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) was reviewed in detail and is described in this article. His technique for vesico-vaginal fistula repair included six essential steps that are still recognizable today: (1) use of the lithotomy position; (2) exposure of the fistula with a speculum; (3) sharp paring of the fistula edge prior to attempted closure; (4) careful approximation of the denuded edges of the fistula; (5) dressing of the wound with absorbent vaginal packing; (6) immobilization of the patient in bed until the repair has healed. CONCLUSIONS: Henry Van Roonhuyse is the most credible candidate presently known for having successfully repaired a vesico-vaginal fistula in the pre-modern era.

J. Marion Sims and the Vesicovaginal Fistula: Historical Understanding, Medical Ethics, and Modern Political Sensibilities.

OBJECTIVES: To review the historical background surrounding the early work of Dr. J. Marion Sims, who developed the first consistently successful surgical technique for the repair of obstetric vesicovaginal fistulas by operating on a group of young, enslaved, African American women who had this condition between 1846 and 1849. METHODS: Review of primary source documents on Sims and his operations, early 19th century clinical literature on the treatment of vesicovaginal fistula, the introduction of ether and chloroform anesthesia into surgical practice, and the literature on the early 19th century medical ethics pertaining to surgical innovation. The goals are to understand Sims's operations within the clinical context of the 1840s and to avoid the problems of "presentism," in which beliefs, attitudes, and practices of the 21st century are anachronistically projected backward into the early 19th century. The object is to judge Sims within the context of his time, not to hold him accountable to standards of practice which were not developed until a century after his death. RESULTS: A narrative of what Sims did is presented within the context of the therapeutic options available to those with fistula in the early 19th century. CONCLUSIONS: Review of the available material demonstrates that Sims' first fistula operations were legal, that they were carried out with express therapeutic intent for the purpose of repairing these women's injuries, that they conformed to the ethical requirements of his time, and that they were performed with the patients' knowledge, cooperation, assent, and assistance.

The portrayal of J. Marion Sims' controversial surgical legacy.

PURPOSE: In the mid 1800s Dr. J. Marion Sims reported the successful repair of vesicovaginal fistulas with a technique he developed by performing multiple operations on female slaves. A venerated physician in his time, the legacy of Dr. Sims is controversial and represents a significant chapter in the mistreatment of African-Americans by the medical establishment. This review compares the modern debate surrounding his legacy with the presentation of his operation in widely consulted urological texts and journals. MATERIALS AND METHODS: A literature review was performed of medical, sociological and periodical sources (1851 to the present) regarding J. Marion Sims and vesicovaginal fistula repair. RESULTS: During the last several decades, while the controversy around Dr. Sims' surgical development has produced a steady stream of articles in the historical and popular literature, relatively little mention is found in standard urology textbooks or journals. With increased public attention, some have debated the removal or modification of public tributes to Dr. Sims. This move has been countered by arguments against the validity of judging a 19th century physician by modern standards. CONCLUSIONS: While historians, ethicists and the popular press have debated Dr. Sims' legacy, medical sources have continued to portray him unquestionably as a great figure in medical history. This division keeps the medical profession uninformed and detached from the public debate on his legacy and, thus, the larger issues of ethical treatment of surgical patients.

[The "prince of surgery," Antoine Jobert de Lamballe (1799-1867) and the first radical cure of vesico-vaginal fistulae with his method of cystoplasty]. / Le "prince de la chirurgie", Antoine Jobert de Lamballe (1799-1867) et la première cure radicale des fistules vésico-vaginales par sa méthode de cystoplastie par glissement.

Jobert de Lamballe, consultant-physician of Louis-Philippe, first surgeon of Napoleon III, Professor of Clinic Surgery, President of the Academy of medicine and member of the Institute, was a very inventive research worker and provided to the surgical technique of his time an essential contribution to the area of intestinal, urologic, gynecologic and plastic surgery. He died, in 1867, by general paresis.

Thomas Addis Emmet, the vesicovaginal fistula, and the origins of reconstructive gynecologic surgery.

Thomas Addis Emmet (1828-1919), the foremost pupil of J. Marion Sims and his successor as chief surgeon at The Woman's Hospital in New York City, was probably the pre-eminent American gynecological surgeon of the last quarter of the 19th century. Among his many achievements were the first critical study of vescovaginal fistula repair, authorship of the first modern scientific textbook of gynecology, the invention of numerous special surgical instruments, pioneering the use of surgical scissors in vaginal operations, and the development of "staged" procedures for surgical reconstruction of the vagina. He was an active writer, a renowned collector of American historical documents and memorabilia, a devout Catholic and a steadfast Irish patriot. This article reviews his life and contributions to gynecologic surgery.

Fistulas vesico vaginales / Vesicovaginal fistulas

Se revisaron: etiología, manejo y seguimiento de las pacientes atendidas en el servicio de urología del Hospital San Juan de Dios de Bogotá, entre enero de 1988 y junio de 1993 con DX de fístula vesico-vaginal con el fin de estandarizar el tratamiento de acuerdo a la localización de la fístula, haciendo énfasis en la técnica quirúrgica. El estudio reunió 20 pacientes tratados en la institución en el período de tiempo mencionado. Con base en la revisión teórica, se diseñó un modelo de historia clínica dirigido al estudio específico de esta patología, que aplicada a las historias de las pacientes en mención, permitió las siguientes conclusiones: - Las pacientes consultaron, desde el momento en que apareció la fístula y hasta 23 años después del inicio de los síntomas. - El tiempo mínimo para intervenir con éxito esta patología debe ser de 8 semanas a partir del momento en que se manifiesta la fístula. - Para las fístulas infratrigonales se propone un acceso vaginal, y el reparo debe hacerse en tres planos con sutura 4-0 de ácido poliglicólico. - Las fístulas supratrigonales, se abordaron por vía transvesical, reparándolas también en tres planos con el mismo tipo de sutura. - Recomendamos para todos los casos una derivación tipo cistostomía durante 14 a 24 días

Ethics in gynecologic surgical innovation.

J. Marion Sims' efforts in surgically curing vesicovaginal fistula are retold. The controversy surrounding his surgical innovation on black slaves is discussed in the context of the ethical principles of autonomy, beneficence, and justice. The relevance of his story to modern surgical innovation in incontinence surgery is emphasized in a discussion of the Pereyra, Gittes, and paravaginal procedures. A call is made to establish a gynecologic ethic to ensure that patients' rights are respected in all future surgical innovation.

The medical ethics of the 'father of gynaecology', Dr J Marion Sims.

Vesico-vaginal fistula (VVF) was a common ailment among American women in the 19th century. Prior to that time, no successful surgery had been developed for the cure of this condition until Dr J Marion Sims perfected a successful surgical technique in 1849. Dr Sims used female slaves as research subjects over a four-year period of experimentation (1845-1849). This paper discusses the controversy surrounding his use of powerless women and whether his actions were acceptable during that historical period.

Fístulas urogenitales en la mujer: algunos aspectos históricos de su tratamiento / Urogenital fistulas in women: some historical aspects of the treatment

Una fístula se caracteriza por trayecto de origen congénito o patológico que da paso a secreciones normales o a productos de eliminación anormales. Las fístulas urogenitales en la mujer son una comunicación anormal entre el aparato urinario y el conducto genital, que da paso a la pérdida de orina. Se trata de lesiones muy molestas; se ven afectadas la paciente y su intimidad social, y se da cuenta de su sintoma casi inmediatamente, lo que constituye uno de los transtornos más devastadores que pueden ocurrir a la mujer. 1.4. En este artículo se revisan aspectos importantes que versan sobre la evolución histórica del tratamiento de esta entidad patológica.

Teste de Huhner ou teste de Sims-Huhner? / Huhner or Sims-Huhner test?

Descreve-se de modo resumido a biografia de J. M. Sims. Mostra-se o processo que o ilustre médico trouxe à cirurgia e ginecologia dos Estados Unidos da América, razäo por que é denominado o "Pai da Ginecologia Norte-americana". Além da magistral contribuiçäo ao tratamento das fístulas vesicovaginais, preocupou-se com o problema da infertilidade e descreveu com detalhes o teste pós-coito em 1866. Apesar de merecidos elogios pelo desempenho profissional, foi considerado pessoa insensível por realizar repetidas operaçöes em escravas negras e em imigrantes pobres de Nova Iorque, no intuito de aperfeiçoamento cirúrgico. Mas Hühner, em 1913, publicou um livro em que expôs os diferentes exames a serem realizados na pesquisa diagnóstica do casal infértil e redescreveu o teste pós-coito. Em 1929 o livro teve uma segunda ediçäo. Em artigo de divulgaçäo de 1924, Hühner enumerou os exames descritos anteriormente e mencionou que médicos daquela época tinha proposto a denominaçäo de "teste de Hühner" ao exame pós-coito por ele relatado como "teste do espermatozóide". Na bibliografia do artigo há citaçäo de um trabalho, posterior ao de 1866, é bem explícito e, além da descriçäo da prova, realça o valor do microscópio e assinala as condiçöes adversas ao teste. Causa estranheza a omissäo de Hühner