RESUMO
Obstetric fistulas are rarely simple. Most patients in sub-Saharan Africa and parts of Asia are carriers of complex fistulas or complicated fistulas requiring expert skills for evaluation and management. A fistula is predictably complex when it is greater than 4 cm and involves the continence mechanism (the urethra is partially absent, the bladder capacity is reduced, or both); is associated with moderately severe scarring of the trigone and urethrovesical junction; and/or has multiple openings. A fistula is even more complicated when it is more than 6 cm in its largest dimension, particularly when it is associated with severe scarring and the absence of the urethra, and/or when it is combined with a recto-vaginal fistula. The present article reviews the evaluation methods and main surgical techniques used in the management of complex fistulas. The severity of the neurovascular alterations associated with these lesions, as well as inescapable limitations in staff, health facilities, and supplies, make their optimal management very challenging.
Assuntos
Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto/classificação , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/cirurgia , Fístula Vesicovaginal/classificação , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgia , Países em Desenvolvimento , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Serviços de Saúde Materna/economia , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Fístula Retovaginal/classificação , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Fístula Vaginal/classificação , Fístula Vaginal/diagnóstico , Fístula Vaginal/cirurgiaRESUMO
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.
