Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 147
Filtrar
1.
Int J Gynaecol Obstet ; 148 Suppl 1: 27-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943188

RESUMO

OBJECTIVE: To describe components of the mobile surgical outreach (MSO) program as a model of care delivery for women with genital fistula; present program results; and discuss operational strengths and challenges. METHODS: A retrospective observational study of routinely collected health data from women treated via the MSO program (2013-2018). The program was developed at Panzi Hospital in the Democratic Republic of Congo to meet the needs of women with fistula living in remote provinces, where travel is prohibited. It includes healthcare delivery, medico-surgical training, and community sensitization components. RESULTS: The MSO team cared for 1517 women at 41 clinic sites across 18 provinces over the study period. Average age at presentation was 31 years (range, 1-81 years). Most women (n=1359, 89.6%) presented with vesicovaginal fistula. Most surgeries were successful, and few women reported residual incontinence postoperatively. Local teams were receptive and engaged in clinical skills training and public health education efforts. CONCLUSION: The MSO program addresses the backlog of patients awaiting fistula surgery and provides a template for a national strategic plan to treat and ultimately end fistula in DRC. It offers a patient-centered approach that brings medico-surgical care and psychosocial support to women with fistula in their own communities.


Assuntos
Fístula Retovaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , República Democrática do Congo/epidemiologia , Feminino , Humanos , Lactente , Pessoa de Meia-Idade , Pobreza , Fístula Retovaginal/complicações , Fístula Retovaginal/epidemiologia , Estudos Retrospectivos , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/epidemiologia , Adulto Jovem
2.
Midwifery ; 82: 102594, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31874317

RESUMO

OBJECTIVE: To explore the experiences of women living with Obstetric Fistula in Ghana. DESIGN: A descriptive qualitative design involving face-to-face semi-structured interviews following institutional ethical approval. SETTING: Urban and rural setting in the Mfantseman Municipal Area (MMA) in the Central Region (CR) of Ghana PARTICIPANTS: A purposive sample of thirty- two women who had experienced obstetric fistula (OBF) FINDINGS: Three core themes emerged and these were i) Women's perceptions of OBF, ii) Experiences of women living with OBF iii) Coping strategies of women living with OBF CONCLUSION AND IMPLICATIONS FOR PRACTICE: There is a need for a multi-agency coordinated approach to the treatment and management of OBF in Ghana. The findings support the need for a dedicated specialist fistula centre to treat women and to meet the educational needs of health care professionals with strategies to prevent as well as support women with OBF. The hub and spoke organisation design for health care systems has proved beneficial in other health settings providing a level of quality that would not be possible otherwise. It is time to end the suffering of women living with obstetric fistula.


Assuntos
Efeitos Psicossociais da Doença , Fístula Vaginal/complicações , Adulto , Idoso , Feminino , Gana , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fístula Retovaginal/complicações , Fístula Retovaginal/psicologia , Estigma Social , Fístula Vaginal/psicologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/psicologia
3.
Pediatr Surg Int ; 35(1): 77-85, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30377757

RESUMO

PURPOSE: Females with recto-vestibular fistula (RVF) can be managed either by one-stage sagittal anorectoplasty (SARP) or by conventional multi-stage approach with colostomy followed by SARP. Our aim was to define which approach, one-stage or multi-stage, is safer and more beneficial. METHODS: Using a defined search strategy, two investigators identified all comparative studies on the mentioned procedures. The study was conducted under PRISMA guidelines. The meta-analysis was performed using RevMan 5.3. Data are mean ± SD. RESULTS: Of 649 titles/abstracts screened, 13 full-text articles were analyzed. Three studies were included (156 females). One-stage SARP was associated with increased risk of wound infection (24.3 ± 8.7%) compared to multi-stage approach (10.9 ± 2.5%; p < 0.01) and increased risk of wound dehiscence (16.2 ± 4.8% vs. 2.4 ± 1.1%, respectively; p < 0.01). The incidence of anorectal stenosis was higher following one-stage repair (33.3%) vs. multi-stage approach (10.7%; p < 0.05). No differences were found with regards to redo SARP in both groups (12.9 ± 7.3% vs. 4.8 ± 0.8%; p = ns). At follow-up, the prevalence of soiling and constipation were similar after one-stage (19.7 ± 10.3% and 29.5 ± 5.4%) and multi-stage repair (13.7 ± 8.9% and 28.7 ± 4.4%; p = ns). CONCLUSIONS: In females with RVF, the SARP performed without protective colostomy increases the risk of postoperative complications. However, this one-stage approach seems not to be associated with reduced fecal continence.


Assuntos
Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Constipação Intestinal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Retovaginal/cirurgia , Reto/cirurgia , Canal Anal/anormalidades , Malformações Anorretais/complicações , Colostomia/métodos , Constipação Intestinal/fisiopatologia , Constipação Intestinal/cirurgia , Defecação , Feminino , Humanos , Fístula Retovaginal/complicações , Reto/anormalidades
4.
Dis Colon Rectum ; 61(6): 733-742, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29664797

RESUMO

BACKGROUND: Curative management of deep infiltrating endometriosis requires complete removal of all endometriotic implants. Surgical approach to rectal involvement has become a topic of debate given potential postoperative bowel dysfunction and complications. OBJECTIVE: This study aims to assess long-term postoperative evacuation and incontinence outcomes after laparoscopic segmental rectal resection for deep infiltrating endometriosis involving the rectal wall. DESIGN: This is a retrospective study of prospectively collected data. SETTINGS: This single-center study was conducted at the University Hospital of Bern, Switzerland. PATIENTS: Patients with deep infiltrating endometriosis involving the rectum undergoing rectal resection from June 2002 to May 2011 with at least 24 months follow-up were included. MAIN OUTCOME MEASURES: Aside from endometriosis-related symptoms, detailed symptoms on evacuation (points: 0 (best) to 21 (worst)) and incontinence (0-24) were evaluated by using a standardized questionnaire before and at least 24 months after surgery. RESULTS: Of 66 women who underwent rectal resection, 51 were available for analyses with a median follow-up period of 86 months (range: 26-168). Forty-eight patients (94%) underwent laparoscopic resection (4% converted, 2% primary open), with end-to-end anastomosis in 41 patients (82%). Two patients (4%) had an anastomotic insufficiency; 1 case was complicated by rectovaginal fistula. Dysmenorrhea, nonmenstrual pain, and dyspareunia substantially improved (p < 0.001 for all comparisons). Overall evacuation score increased from a median of 0 (range: 0-11) to 2 points (0-15), p = 0.002. Overall incontinence also increased from 0 (range: 0-9) to 2 points (0-9), p = 0.003. LIMITATIONS: This study was limited by its retrospective nature and moderate number of patients. CONCLUSIONS: Laparoscopic segmental rectal resection for the treatment of deep infiltrating endometriosis including the rectal wall is associated with good results in endometriotic-related symptoms, although patients should be informed about possible postoperative impairments in evacuation and incontinence. However, its clinical impact does not outweigh the benefit that can be achieved through this approach. See Video Abstract at http://links.lww.com/DCR/A547.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/cirurgia , Enteropatias/complicações , Pelve/patologia , Doenças Retais/cirurgia , Reto/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Colectomia/métodos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Dismenorreia/etiologia , Dispareunia/etiologia , Endometriose/complicações , Endometriose/patologia , Incontinência Fecal/complicações , Feminino , Humanos , Enteropatias/fisiopatologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Doenças Retais/complicações , Doenças Retais/patologia , Fístula Retovaginal/complicações , Fístula Retovaginal/etiologia , Estudos Retrospectivos , Suíça/epidemiologia , Resultado do Tratamento
5.
Midwifery ; 50: 55-61, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28390255

RESUMO

OBJECTIVE: to explore the cultural, social and economic needs and challenges of women in northern Ghana as they resume their day-to-day lives post obstetric fistula repair. DESIGN: a critical ethnographic approach. SETTING: a state run fistula treatment center in Tamale, northern Ghana, and 24 rural communities in northern Ghana. PARTICIPANTS: ninety-nine (N=99) participants were recruited using purposive, convenience and snowball sampling. The sample consisted of women (N=41) who had experienced an obstetric fistula repair and their family members (N=24). Health care providers (N=17) and stakeholders (N=17) who had specialised knowledge about reintegration programs at a community or national level were also included. FINDINGS: the needs and challenges of northern Ghanaian women post obstetric fistula repair were historically and culturally rooted. A woman's psychosocial acceptance back into her community post obstetric fistula was significant to her well-being but many women felt they had to 'prove' themselves worthy of acceptance and hid any signs of urinary incontinence post obstetric fistula repair. The cost of treatment compounded by a woman's inability to work while having the obstetric fistula exaggerated her economic needs. Skills training programs offered assistance but were often not suited to a woman's physical capability or geographic location. Many women who have experienced obstetric fistula along with women leaders have initiated obstetric fistula awareness campaigns in their communities with the aim of overcoming the challenges and improving the reintegration experiences of others who have had an obstetric fistula repair. CONCLUSION: developing understanding about the needs and challenges of women post obstetric fistula is an important step forward in creating social and political change in obstetric fistula care and reintegration. IMPLICATIONS FOR PRACTICE: Strategies to support women reintegrating to their communities post obstetric fistula repair include exploring alternative forms of skills training and income generation activities, creating innovative pre and post obstetric fistula health education and community awareness to reduce the perception of the condition as 'incurable', and promoting peer advocacy.


Assuntos
Fístula Retovaginal/psicologia , Fístula Vesicovaginal/psicologia , Adolescente , Adulto , Antropologia Cultural/métodos , Feminino , Gana , Acesso aos Serviços de Saúde/normas , Humanos , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/psicologia , Gravidez , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Fístula Retovaginal/complicações , Fístula Retovaginal/etiologia , População Rural , Estigma Social , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/etiologia
6.
BMC Infect Dis ; 17(1): 150, 2017 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-28209132

RESUMO

BACKGROUND: Urinary Tract Infection (UTI) causes a serious health problem and affects millions of people worldwide. Patients with obstetric fistula usually suffer from incontinence of urine and stool, which can predispose them to frequent infections of the urinary tract. Therefore the aim of this study was to determine the etiologic agents, drug resistance pattern of the isolates and associated risk factor for urinary tract infection among fistula patients in Addis Ababa fistula hospital, Ethiopia. METHODS: Across sectional study was conducted from February to May 2015 at Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Socio-demographic characteristics and other UTI related risk factors were collected from study participants using structured questionnaires. The mid-stream urine was collected and cultured on Cysteine lactose electrolyte deficient agar and blood agar. Antimicrobial susceptibility was done by using disc diffusion method and interpreted according to Clinical and Laboratory Standards Institute (CLSI). Data was entered and analyzed by using SPSS version 20. RESULTS: Out of 210 fistula patients investigated 169(80.5%) of the patient were younger than 25 years. Significant bacteriuria was observed in 122/210(58.1%) and 68(55.7%) of the isolates were from symptomatic cases. E.coli 65(53.7%) were the most common bacterial pathogen isolated followed by Proteus spp. 31(25.4%). Statistical Significant difference was observed with history of previous UTI (P = 0.031) and history of catheterization (P = 0.001). Gram negative bacteria isolates showed high level of resistance (>50%) to gentamicin and ciprofloxacin, while all gram positive bacteria isolated were showed low level of resistance (20-40%) to most of antibiotic tested. CONCLUSIONS: The overall prevalence of urinary tract infection among fistula patient is 58.1%. This study showed that the predominant pathogen of UTI were E.coli followed by Proteus spp. It also showed that amoxicillin-clavulanic acid was a drug of choice for urinary tract bacterial pathogens.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Incontinência Fecal/complicações , Fístula Retovaginal/complicações , Incontinência Urinária/complicações , Infecções Urinárias/etiologia , Adolescente , Adulto , Bacteriúria/epidemiologia , Criança , Etiópia/epidemiologia , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Gravidez , Prevalência , Fístula Retovaginal/epidemiologia , Fístula Retovaginal/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Adulto Jovem
7.
Prog Urol ; 27(4): 229-237, 2017 Mar.
Artigo em Francês | MEDLINE | ID: mdl-28065390

RESUMO

INTRODUCTION: Rectovaginal fistula requires a complex management because it has an important psychological impact associated with impaired quality of life of patients. Thus, the aim of our study was to evaluate the improvement of the quality of life of patients after surgical management. METHODS: This is a retrospective study. We included patients operated between 2009 and 2014 for the treatment of a rectovaginal fistula, whose data were available and who agreed to answer a questionnaire. We evaluated the satisfaction of short-term and long-term patients on the answer to the basic PFDI-20 and PFIQ-7 questionnaires. We then evaluated whether there was an improvement in symptoms and quality of life after surgery. RESULTS: Nine patients were included but only 4 patients completed the PFDI-20 and PFIQ-7 questionnaires. Fistula was secondary to either surgical intervention (44%, n=4) or complicated perineal tear (44%, n=4) or unknown cause (11%, n=1). After surgery, we found the short term a significant decrease in stool incontinence, as there was no stool incontinence (0/5) in the postoperative period, while preoperatively 55% (5/9) (P=0.03). Postoperatively, 33% (3/9) of the patients had genital discomfort and 44% (4/9) had gas incontinence compared to 0% preoperatively (P=0.2 and P=0.6). There appears to be an improvement in pelvic static disorders after surgical management. However, we found a slight improvement in nauseous leucorrhoea in the immediate postoperative period, as the prevalence decreased from 33% (3/9) preoperatively to 22% (2/9) postoperatively (P>0.9). In the long term, we observed an improvement in the sensation of perineal heaviness and gas incontinence because only 25% (1/4) of the 75% (3/4) preoperative patients still showed slight discomfort (P=0.5). The quality of life and the emotional state of the patients were no altered postoperatively. Indeed, preoperatively, 50% (2/4) of the patients reported anxiety compared to 0% (0/4) postoperatively (P=0.4). Similarly, 75% (3/4) complained of a decrease in their quality of life (social, sports, etc.) preoperatively compared with 0% (0/4) postoperatively (P>0.9). CONCLUSION: A simple surgical management of rectovaginal fistulas would allow a significant decrease in stool incontinence and improved quality of life and their emotional state, which confirms the beneficial effect of this therapeutic strategy. LEVEL OF EVIDENCE: 4.


Assuntos
Qualidade de Vida , Fístula Retovaginal/cirurgia , Adulto , Idoso , Ansiedade/etiologia , Incontinência Fecal/etiologia , Feminino , Flatulência/etiologia , Humanos , Leucorreia/etiologia , Pessoa de Meia-Idade , Fístula Retovaginal/complicações , Fístula Retovaginal/psicologia , Estudos Retrospectivos , Inquéritos e Questionários
8.
Obstet Gynecol ; 128(6): 1365-1368, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27824744

RESUMO

BACKGROUND: An enterovaginal or vesicovaginal fistula is a complication resulting in vaginal discharge of succus, urine, or stool that can lead to significant complications. For low-volume fistulae, tampons or pads may be used. With high-volume fistulae, frequent product change can be painful and unpredictable in terms of efficacy. The psychologic distress is profound. Surgery may not be an option, making symptom control the priority. INSTRUMENT: We report the use of a reusable menstrual silicone vaginal cup placed to divert and contain drainage. EXPERIENCE: The menstrual cup provided significant symptom relief. Drainage is immediately diverted from tissue, unlike with tampon or pad use, which involves longer contact periods with caustic fluids. A system was created by adapting the end of the cup by adding silastic tubing and an external leg bag to provide long-term drainage control. CONCLUSION: Improvement in quality of life is of primary importance when dealing with fistula drainage. This simple and inexpensive device should be considered in those cases in which the drainage can be diverted as a viable option, especially in those who are symptomatic and awaiting surgical repair or in those for whom surgery cannot be performed.


Assuntos
Desenho de Equipamento , Intestino Delgado , Produtos de Higiene Menstrual , Fístula Retovaginal/terapia , Tampões Cirúrgicos , Fístula Vesicovaginal/terapia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Fístula Retovaginal/complicações , Silicones , Fístula Vesicovaginal/complicações
10.
Am J Case Rep ; 17: 448-53, 2016 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-27373845

RESUMO

BACKGROUND This study reports the pathogenesis of anal canal adenocarcinoma in a patient with longstanding Crohn's disease (CD). CASE REPORT A 50-year-old woman with a 33-year history of CD presented with perianal pain of several months' duration. She had been treated surgically for a rectovaginal fistula 26 years earlier and had been treated with infliximab (IFX) for the previous 4 years. A biopsy under anesthesia revealed an anal canal adenocarcinoma, which was removed by abdominoperineal resection. Pathological examination showed that a large part of the tumor consisted of mucinous adenocarcinoma at the same location as the rectovaginal fistula had been removed 26 years earlier. There was no evidence of recurrent rectovaginal fistula, but thick fibers surrounded the tumor, likely representing part of the previous rectovaginal fistula. Immunohistochemical analysis using antibodies against cytokeratins (CK20 and CK7) revealed that the adenocarcinoma arose from the rectal mucosa, not the anal glands. CONCLUSIONS Mucinous adenocarcinoma can arise in patients with CD, even in the absence of longstanding perianal disease, and may be associated with adenomatous transformation of the epithelial lining in a former fistula tract.


Assuntos
Adenocarcinoma/etiologia , Canal Anal/diagnóstico por imagem , Neoplasias do Ânus/etiologia , Doença de Crohn/complicações , Mucosa Intestinal/diagnóstico por imagem , Fístula Retovaginal/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Anastomose Cirúrgica/efeitos adversos , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/cirurgia , Biópsia , Colectomia , Colonoscopia , Doença de Crohn/diagnóstico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/cirurgia , Reto/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Vagina/cirurgia
11.
J Clin Gastroenterol ; 50(9): 714-21, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27466166

RESUMO

BACKGROUND: Rectovaginal and enterovesical fistulae are difficult to treat in patients with Crohn's disease. Currently, there is no consensus regarding their appropriate management. AIM OF THE STUDY: The aim of the study was to review the literature on the medical management of rectovaginal and enterovesical fistulae in Crohn's disease and to assess their response to treatment. METHOD: A literature search of MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane was performed. RESULTS: Twenty-three studies were identified, reporting on 137 rectovaginal and 44 enterovesical fistulae. The overall response rates of rectovaginal fistulae to medical therapy were: 38.3% complete response (fistula closure), 22.3% partial response, and 39.4% no response. For enterovesical fistulae the response rates to medical therapy were: 65.9% complete response, 20.5% partial response, and 13.6% no response. Specifically, response to anti-tumor necrosis factor therapy of 78 rectovaginal fistulae was: 41.0% complete response, 21.8% partial response, and 37.2% no response. Response of 14 enterovesical fistulae to anti-tumor necrosis factor therapy was: 57.1% complete response, 35.7% partial response, and 7.1% no response. The response to a combination of medical and surgical therapy in 43 rectovaginal fistulae was: 44.2% complete response, 20.9% partial response, and 34.9% no response. CONCLUSIONS: Medical therapy, alone or in combination with surgery, appears to benefit some patients with rectovaginal or enterovesical fistula. However, given the small size and low quality of the published studies, it is still difficult to draw conclusions regarding treatment. Larger, better quality studies are required to assess response to medical treatment and evaluate indications for surgery.


Assuntos
Doença de Crohn/complicações , Fístula Intestinal/terapia , Fístula Retovaginal/terapia , Fístula da Bexiga Urinária/terapia , Terapia Combinada , Feminino , Humanos , Fístula Intestinal/complicações , Fístula Retovaginal/complicações , Resultado do Tratamento , Fístula da Bexiga Urinária/complicações
12.
BMC Womens Health ; 16: 5, 2016 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-26809986

RESUMO

BACKGROUND: About two thirds of patients with cervical cancer in Tanzania present with advanced tumor stage, leading to significant morbidity and mortality. We designed a study to determine the factors associated with the late tumour stage at presentation among patients with cervical cancer in Mwanza. METHODS: This cross-sectional study recruited women at Bugando Medical Centre (BMC) with histologically confirmed cervical cancer from November 2013 to April 2014. Patients were recruited serially until the sample size was reached. RESULTS: A total of 202 women with histologically confirmed cervical cancer were recruited. The mean age of the patients was 50.5 ± 13.3 years. The majority of patients (n = 129, 63.9%) were diagnosed with late stage disease (IIB-IVB). Patients also presented with severe anemia (n = 78, 38.6%), urinary tract infections (n = 74, 36.6%), hydronephrosis (n = 43, 21.2%), elevated serum creatinine levels (n = 33, 16.3%), vesicovaginal fistula (VVF), (n = 13, 6.4%), lung metastasis (n = 5, 2.4%), metastasis to the urinary bladder (n = 4, 1.9%), rectovaginal fistula (RVF) (n = 3, 1.4%), liver metastasis (n = 2, 0.9%) and hydroureter (n = 2, 0.9%). In multivariate logistic regression, factors associated with late stage at presentation were attending to alternative health practitioners and lack of personal initiative to seek care to formal health facilities (OR 2.3; 95% CI 1.2-4.2, p = 0.011 and OR 2.0; 95 % CI 1.0-3.8, p = 0.028) respectively. CONCLUSION: Communities should be sensitized to women's empowerment, provide community education on early symptoms of cervical cancer, and the importance of early hospital attendance.


Assuntos
Estadiamento de Neoplasias/estatística & dados numéricos , Síndrome , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Fístula Retovaginal/complicações , Tanzânia , Fístula Vesicovaginal/complicações
13.
Reprod Health ; 12: 115, 2015 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-26683687

RESUMO

BACKGROUND: Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. METHODS: This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. DISCUSSION: This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.


Assuntos
Fístula Retovaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Humanos , Estudos Longitudinais , Complicações do Trabalho de Parto , Gravidez , Qualidade de Vida , Recuperação de Função Fisiológica , Fístula Retovaginal/complicações , Fístula Retovaginal/psicologia , Projetos de Pesquisa , Apoio Social , Fatores de Tempo , Resultado do Tratamento , Uganda , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/psicologia
14.
BMC Womens Health ; 15: 107, 2015 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-26603842

RESUMO

BACKGROUND: Obstetric fistula is a worldwide problem that affects women and girls mostly in Sub Saharan Africa. It is a devastating medical condition consisting of an abnormal opening between the vagina and the bladder or rectum, resulting from unrelieved obstructed labour. Obstetric fistula has devastating social, economic and psychological effect on the health and wellbeing of the women living with it. This study aimed at exploring social-cultural experiences of women living with obstetric fistula in rural Tanzania. METHODS: Women living with obstetric fistula were identified from the fistula ward at CCBRT hospital. Sixteen individual semi structured interviews and two (2) focus group discussions were conducted among consenting women. Interviews were transcribed verbatim and transcripts analysed independently by two researchers using a thematic analysis approach. Themes related to the experiences of living with obstetric fistula were identified. RESULTS: Four themes illustrating the socio-cultural experiences of women living with obstetric fistula emerged from the analysis of women experiences of living with incontinence and odour. These were keeping clean and neat, earning an income, maintaining marriage, and keeping association. Women experiences of living with fistula were largely influenced by perceptions of people around them basing on their cultural understanding of a woman. CONCLUSION: Living with fistula reveals women's day-to-day experiences of social discrimination and loss of control due to incontinence and odour. They cannot work and contribute to the family income, cannot satisfy their husband's sexual needs and or bear children, and cannot interact with members of the community in social activities. Women experience of living with fistula was influenced by perceptions of people around them. In the eyes of these people, women who leak urine were of less value since they were not capable of carrying out ascribed social roles.


Assuntos
Odorantes , Fatores Sociológicos , Incontinência Urinária/complicações , Incontinência Urinária/psicologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/psicologia , Gravidez , Pesquisa Qualitativa , Fístula Retovaginal/complicações , Fístula Retovaginal/psicologia , População Rural , Tanzânia
15.
BMJ Case Rep ; 20152015 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-26490998

RESUMO

Anorectal malformations consist of a wide spectrum of conditions which can affect both sexes and involve the distal anus and rectum as well as the urinary and genital tracts. Patients have the best chance of a good functional outcome if the condition is diagnosed early and efficient anatomic repair is promptly instituted. This report describes a rare case of imperforate anus associated with both rectovaginal and rectocutaneous fistulas in a 6-year-old Filipino girl. The case highlights shortcomings in the healthcare delivery system combined with socio-economic factors that contributed to the delay in both diagnosis and the institution of adequate treatment. Care and preventive measures that can be implemented in low-resource settings to reduce the impact of birth defects are also discussed.


Assuntos
Canal Anal/anormalidades , Canal Anal/cirurgia , Anus Imperfurado/diagnóstico , Anus Imperfurado/cirurgia , Anormalidades Congênitas/cirurgia , Fístula Retovaginal/cirurgia , Reto/anormalidades , Malformações Anorretais , Criança , Países em Desenvolvimento , Feminino , Saúde Global , Acesso aos Serviços de Saúde , Humanos , Filipinas , Fístula Retovaginal/complicações , Reto/cirurgia
16.
Arch. esp. urol. (Ed. impr.) ; 68(2): 187-190, mar. 2015.
Artigo em Espanhol | IBECS | ID: ibc-134483

RESUMO

Se presentan dos casos de fístula, enterovaginal y enterocutánea asociadas a tratamiento con pazopanib, un inhibidor de la angiogénesis para el tratamiento de cáncer renal metastásico. El tiempo entre el inicio del fármaco y la aparición de la fístula fue de 6 y 16 meses, respectivamente; en ninguno de los casos hubo antecedentes de radioterapia o cirugía previa en la zona donde surgió la complicación. Según lo reportado en la literatura, alrededor de un 70% de pacientes se benefician de un tratamiento conservador. Las fístulas enterovaginales y enterocutáneas, suponen menos del 1% de las complicaciones publicadas por el uso de fármacos antiangiogénicos; a pesar de eso, es una complicación que deberíamos tener presente, pues se reporta una mortalidad cercana al 30%. A través de este artículo, queremos trasmitir nuestra experiencia en este tipo de complicación, ya por su baja incidencia, es indudable, que esta por vía de información, nos podemos apoyar los diferentes especialistas que tratan a estos pacientes; tomando las precauciones necesarias y decidiendo un manejo adecuado


We present two cases of enterovaginal and enterocutaneous fistulae associated to treatment with pazopanib, which is an angiogenesis inhibitor for the treatment of metastatic renal cancer. The times from drug administration and the first appearance of a fistula were 6 and 16 months, respectively. None of the cases had a history of surgery or radiotherapy in the area where the complication was observed. Enterovaginal and enterocutaneous fistula represent less than 1% of all published complications caused by the use of antiangiogenic drugs. However, they must be taken into account as the reported mortality rate is close to 30%. Given its low incidence, we believe that sharing this data is a great way to help specialists who have to treat these patients to take the necessary precautions and decide on an adequate approach


Assuntos
Humanos , Feminino , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico , Neoplasias Renais/tratamento farmacológico , Fístula Retovaginal/complicações , Fístula Retovaginal/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Inibidores da Angiogênese/metabolismo , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia
17.
J Pediatr Adolesc Gynecol ; 28(2): e17-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25444054

RESUMO

BACKGROUND: Congenital absence of uterus and vagina (CAUV) when associated with anorectal malformations is usually diagnosed and repaired in infancy at the time of anorectoplasty. Long-term observations of patients are scarce and do not justify early vaginal reconstruction. Question arises whether creation of a neovagina can be safely and successfully performed when the patient is mature. CASE: The patient, diagnosed with MRKH syndrome at 16 years of age, underwent repair of rectovestibular fistula and imperforate anus ("cut-back" procedure, temporal sigmostomy and sagittal anterior anorectoplasty) in infancy. At 18, modified Wharton vaginoplasty was performed with a good anatomico-functional outcome. SUMMARY AND CONCLUSIONS: Early repair of anorectal malformation and postponed vaginal reconstruction seem to be a viable option for patients with congenital rectovestibular fistula and anal atresia concomitant with CAUV.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Anus Imperfurado/cirurgia , Anormalidades Congênitas/cirurgia , Ductos Paramesonéfricos/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Retovaginal/cirurgia , Vagina/cirurgia , Transtornos 46, XX do Desenvolvimento Sexual/complicações , Adolescente , Anus Imperfurado/complicações , Feminino , Humanos , Ductos Paramesonéfricos/cirurgia , Fístula Retovaginal/complicações , Vagina/anormalidades
18.
BMC Womens Health ; 14: 136, 2014 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-25380616

RESUMO

BACKGROUND: Obstetric fistula is essentially a result of pelvic injury caused by prolonged obstructed labour. Foot drop and walking difficulties in some of these women signify that the injury may extend beyond the loss of tissue that led to the fistula. However, these aspects of the pelvic injury are scarcely addressed in the literature. Here we specifically aimed at assessing musculoskeletal function in women with obstetric fistula to appreciate the extent of the sequelae of their pelvic injury. METHODS: This case-control study compared 70 patients with obstetric fistula with 100 controls matched for age and years since delivery. The following was recorded: height, weight, past and present walking difficulties, pain, muscle strength and joint range of motion, circumference and reflexes. Differences between groups were analysed using independent sample t-test and chi-square test for independence. RESULTS: A history of leg pain was more common among cases compared to controls, 20% versus 7% (p = 0.02), and 29% of the cases had difficulties walking following the injuring delivery compared to none of the controls (p ≤ 0.001). Of these, four women reported spontaneous recovery. Cases had 7° less range of motion in ankle dorsal flexion (95%CI: -8.1, -4.8), 8° less ankle plantar flexion (95%CI: -10.6, -6.5), 12° less knee flexion (95%CI: -14.1, -8.9), and 4° less knee extension (95%CI: 2.9, 5.0) compared to controls. Twelve % of the cases had lower ankle dorsal flexion strength (p = 0.009). Foot drop was present in three (4.3%) compared with none among controls. Women with fistula had 4° greater movement in hip extension (95%CI: -5.9, -3.1), 2° greater hip lateral rotation (95%CI: 0.7, 3.3) and 9° greater hip abduction (95%CI: 6.4, 10.7). Twelve % of the cases had stronger medial rotation in the hip (p = 0.04), 20% had stronger hip lateral rotation (p ≤ 0.001), 29% had stronger hip extension (p ≤ 0.001), and 15% had stronger hip abduction (p = 0.04) than controls. CONCLUSIONS: Women with obstetric fistula commonly experienced walking difficulties after the delivery, had often leg pain and reduced function in the ankle and knee joints that may have been compensated by increased motion and strength in the hip.


Assuntos
Extremidade Inferior/fisiopatologia , Limitação da Mobilidade , Força Muscular , Amplitude de Movimento Articular , Fístula Retovaginal/complicações , Fístula Vesicovaginal/complicações , Adolescente , Adulto , Idoso , Articulação do Tornozelo/fisiopatologia , Estudos de Casos e Controles , Parto Obstétrico/efeitos adversos , Feminino , Transtornos Neurológicos da Marcha/etiologia , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior/patologia , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Dor Musculoesquelética/etiologia , Fístula Retovaginal/fisiopatologia , Reflexo , Fístula Vesicovaginal/fisiopatologia , Caminhada/fisiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...