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1.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504516

RESUMO

A premenopausal patient in her late forties presented with a 15-year history of urinary incontinence starting shortly after a caesarean section performed for her fourth delivery and more recently associated episodic light haematuria and passage of clots per vagina. The haematuria was intermittent over several months and associated with per-vaginal bleeding. She had symptomatic anaemia. Flexible cystoscopy and MRI showed a vesicouterine fistula. She underwent a robotic-assisted hysterectomy and multi-layered repair of the bladder with omental interposition. She remained in the hospital for 4 days, though recovered well and underwent catheter removal at 14 days following a normal cystogram. At 3 months, she was well with no incontinence or urinary symptoms. This case demonstrates the need for vigilance in assessing patients with persistent incontinence, particularly in the context of prior caesarean section. It highlights the feasibility of robotic surgery for correcting these defects in a society where minimally invasive surgery is becoming the norm, and cosmesis is a priority for patients.


Assuntos
Cesárea , Diagnóstico Tardio , Complicações Pós-Operatórias/diagnóstico por imagem , Fístula Vesicovaginal/diagnóstico por imagem , Cistoscopia , Feminino , Humanos , Histerectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgia
2.
Int J Gynaecol Obstet ; 149(2): 178-183, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32010960

RESUMO

OBJECTIVE: To understand how the physical etiology of sexual dysfunction among women with obstetric fistulas can inform repair. METHODS: A prospective cohort study included women aged 18 years or over presenting at the Fistula Care Center, Bwaila Maternity Hospital, Lilongwe, Malawi, with obstetric vesicovaginal fistula before and after repair. The study took place between January 1, 2018, and December 31, 2018, and involved physical examinations and interviews. The primary outcome was sexual function. RESULTS: 115 were interviewed before and after repair. 44 (40.0%) preoperatively and 14 (12.2%) postoperatively reported sexual dysfunction. 94 women (81.7%) had little or no interest in sexual activity before repair. 55 women (47.8%) had little or no interest in sexual activity after repair. Before surgery, 69 women (60.0%) were not sexually active in the 30 days before coming to the Fistula Care Centre. After surgery, 32 women (27.8%) were not sexually active in the 30 days before returning to the Fistula Care Centre. Of those who were not sexually active in the 30 days before coming to the Fistula Care Centre (n=69), the majority cited their health as a reason before repair (n=45, 65.2%), while the most commonly cited reason after repair was an absent partner (n=23, 35%). CONCLUSION: Given the significant percentage of women with obstetric fistula reporting sexual dysfunction after repair, a more holistic perspective of health outcomes should be considered. Further investment should be made in screening tools and surgical techniques targeting sexual dysfunction.


Assuntos
Disfunções Sexuais Fisiológicas/etiologia , Fístula Vesicovaginal/complicações , Adolescente , Adulto , Idoso , Feminino , Humanos , Malaui , Pessoa de Meia-Idade , Período Pós-Operatório , Gravidez , Estudos Prospectivos , Comportamento Sexual/estatística & dados numéricos , Fístula Vesicovaginal/cirurgia , Adulto Jovem
3.
Int J Gynaecol Obstet ; 148 Suppl 1: 22-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943180

RESUMO

Although approximately 2 million women suffer from an obstetric fistula, the surgical literature is sparse. This review examines the evidence published to date. The most relevant surgical evidence is included, highlighting the need for further scientific investigations to contribute to our surgical practice. The most pressing needs relate to anti-incontinence techniques and complex obstetric fistula repairs.


Assuntos
Incontinência Urinária/etiologia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Saúde Global , Humanos , Gravidez , Incontinência Urinária/terapia , Fístula Vesicovaginal/complicações , Saúde da Mulher
4.
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
5.
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
6.
Mymensingh Med J ; 28(1): 206-213, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30755571

RESUMO

Genitourinary fistula is a psychophysiosocial distress that results in prolonged labour. Gradually, it has become a public health issue globally with advancing of its incidence day by day. A handsome number of mothers are also suffering in Bangladesh from genitourinary fistula. This study was done to observe the patterns of presentations of genitourinary fistula and their fetal outcome. One hundred sixteen (116) consecutive patients were enrolled in the study by purposive sampling as a diagnosed case of genitourinary fistula presented in Department of Obstetrics & Gynecology of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2017 to September 2017. It was a prospective observational cross-sectional study. A pre-structured, interview and observation based, peer reviewed data collection sheet was prepared. Data regarding sociodemographic, clinical and Obstetrical profile were recorded. Statistical analysis was done with SPSS version 23. Data were presented as mean and standard deviation, frequency and percentage with range. The mean age of the respondents was 27.27±4.21 (age range: 20-35 years). The mean height of the respondents was 150.26±13.28cm (range: 133-172cm). Among 106 mothers 69(65.1%) and 25(23.6%) were primiparous and multiparous respectively. On the contrary, 5(4.7%) each were grand multiparous and experienced fistula due to non obstetrics complications like malignancy, hysterectomy and radiotherapy. Mothers had 1, 2 and 3 fistulas in 98(92.5%), 6(5.7%) and 2(1.9%) respectively. Among 106 mothers, 99(93.4%) experienced only urinary incontinence whereas 5(4.7%) experienced fecal incontinence. Only 2(1.9%) experienced both urinary and fecal incontinence. Maximum vesicovaginal fistula was due to obstructed labour (65.09%) which was subsequently followed by trauma (14.15%). Vesicovaginal fistula was the commonest type which was subsequently followed by vesicocervical fistula. Among 106 mothers, 73(68.9%) and 25(23.6%) gave birth, still birth and alive babies respectively. On the contrary, 4(3.7%) neonate experienced death in neonatal period whereas 1(0.9%) each twin deliveries resulted in 'one dead and one alive' and 'Twin alive' respectively. In case of only 3(2.8%) mothers 'no information' regarding fetal outcome could be recorded. Prolonged labour is the principal culprit to develop genitourinary fistulas among which VVF is the commonest variety. Still birth is the frequently evident fetal outcome in case of this clinical disaster of pregnancy.


Assuntos
Incontinência Fecal/etiologia , Complicações do Trabalho de Parto/epidemiologia , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/cirurgia , Adulto , Bangladesh , Estudos Transversais , Incontinência Fecal/epidemiologia , Feminino , Humanos , Histerectomia , Lactente , Recém-Nascido , Complicações do Trabalho de Parto/etiologia , Gravidez , Estudos Prospectivos , Resultado do Tratamento , Incontinência Urinária/epidemiologia , Fístula Vesicovaginal/epidemiologia , Adulto Jovem
7.
Prog. obstet. ginecol. (Ed. impr.) ; 62(1): 55-58, ene.-feb. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184896

RESUMO

Introducción: las fístulas vesicouterinas son entidades poco frecuentes representando entre el 1 y el 4% de todas las fístulas urogenitales. En el 83% de las ocasiones se establece el antecedente de cesárea segmentaria trans-versa. La clínica es variable, pudiéndose asociar la presencia de incontinencia de orina, menuria y amenorrea. Caso clínico: el caso descrito en este artículo resulta de especial interés debido al diagnóstico pasados dos años del antecedente de cesárea junto con la presencia de incontinencia urinaria y menuria. Como tratamiento se optó por la cirugía vía laparoscópica con reparación vesical e histerectomía por deseos genésicos cumplidos. Discusión: según la bibliografía revisada sobre esta patología el diagnóstico se realiza mediante técnicas de imagen como la cistografía e histeroscopia con azul de metileno. El tratamiento quirúrgico con reparación de la fístula se sabe que presenta resultados satisfactorios; se puede optar por el tratamiento conservador en los casos de fístulas de pequeño tamaño y diagnosticadas precozmente


Introduction: Vesicouterine fistulas are a rare entity, representing between 1 and 4 % of all the urogenital fistulas. In up to 83% of cases there is a previous segmental transverse cesarean section. Clinical manifestations are diverse, and might simultaneously comprise urinary incontinence, menouria and amenorrhea. Case report: The case reported in this article is of special interest due to the delayed diagnosis, two years after the cesarean section, presenting symptoms being urinary incontinence and menouria. The patient was treated with laparoscopic bladder reparation and hysterectomy due to fulfilled reproductive expectations. Discussion: Based on a literature review of the topic diagnosis is established with imaging techniques, such as cystography and hysteroscopy with methylene blue. Surgical repair shows good results, although a conservative approach might be preferred for small and early-diagnosed fistulas


Assuntos
Humanos , Feminino , Adulto , Fístula Vesicovaginal/diagnóstico , Incontinência Urinária/etiologia , Descarga Vaginal/etiologia , Fístula Vesicovaginal/complicações , Cistoscopia/métodos , Cistografia/métodos , Complicações Pós-Operatórias , Cesárea
9.
J Obstet Gynaecol ; 38(6): 822-827, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29523027

RESUMO

Kitovu Hospital in Masaka, Uganda, is a leading obstetric fistula repair centre in the country with the highest rates of fistula in the world. In this retrospective case review, the regional incidence and causative factors were studied in patients with vesicovaginal fistula (VVF) who were admitted at Kitovu Hospital. Fistula history included severity (ICIQ score), causes and outcomes of VVF were measured. Women suffered with symptoms of VVF for an average of 4.97 years with an average ICIQ severity score of 7.21. Patients travelled an average distance of 153 km and the majority travelled by public transport. Rates of prolonged labour were high. 69% of fistula-causing delivery resulted in stillbirth and 12% resulted in early neonatal death. Following surgery, 94% of patients were dry on discharge. Impact statement What is already known on this subject? Vesicovaginal fistula (VVF) is a severe, life-changing injury. Although largely eradicated from the Western world thanks to modern obstetric practice, VVF is still highly prevalent in developing countries where factors such as young childbearing age and poor access to emergency obstetric care increase the incidence (Wall et al. 2005 ). At the current rate of fistula repair, it is estimated that it would take 400 years to treat those already suffering with fistula, providing that no new cases emerged (Browning and Patel 2004 ). What do the results of this study add? The Ugandan women in this study reiterate tales of foetal loss, social isolation and epic journeys in search of fistula repair, as previously described in the literature. The study offers some hope for prompt help-seeking during labour and after fistulas are developed. It demonstrates the success of fistula repairs at Kitovu Hospital but highlights the paucity of service provision across Uganda. What are the implications of these findings for clinical practice and/or further research? Further epidemiological research is required to quantify the true burden of the disease. Only by raising the profile of VVF in both developing and developed countries, can there be a collaborative effort to make universal change. To embark upon the prevention and cure of the disease it is necessary to continue tackling issues of poverty and gender inequality.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Fístula Vesicovaginal/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/etiologia , Gravidez , Prevalência , Estudos Retrospectivos , Uganda/epidemiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/cirurgia , Adulto Jovem
10.
BJOG ; 125(6): 751-756, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28981186

RESUMO

Gynecologic and plastic surgeons collaborate to improve vaginal reconstruction for women with vaginal stenosis and obstetric fistula. As these cases occur typically in low-resource settings, the Singapore flap is a useful technique given its reliability, safety, ease of dissection, and minimal need for additional supplies. The fasciocutaneous flap maintains cutaneous innervation and vasculature and does not require stenting. The surgical collaboration has made it possible to provide functional vaginal reconstruction as a part of the overall care of obstetric fistula patients. The technique shows promise for improving sexual function for women with obstetric fistula and may also enhance healing. TWEETABLE ABSTRACT: Gynecologic & plastic surgeons collaborate to improve vaginal reconstruction for women with obstetric fistula.


Assuntos
Complicações na Gravidez/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Vagina/cirurgia , Fístula Vesicovaginal/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Humanos , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/patologia , Resultado do Tratamento , Vagina/patologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/patologia , Adulto Jovem
12.
Arch Gynecol Obstet ; 296(1): 1-3, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28573407

RESUMO

Vesicovaginal fistulae are rarely seen after childbirth in developed countries. This article deals with the causes, presentation, and management of obstetric vesicovaginal fistulae in patients treated at a German women's hospital.


Assuntos
Complicações do Trabalho de Parto , Fístula Vesicovaginal/complicações , Adulto , Cesárea/efeitos adversos , Feminino , Alemanha , Humanos , Parto , Gravidez , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/patologia , Fístula Vesicovaginal/cirurgia
13.
Prog. obstet. ginecol. (Ed. impr.) ; 60(3): 252-255, mayo-jun. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-164072

RESUMO

Las fístulas vesicovaginales están entre las complicaciones más angustiantes de los procedimientos ginecológicos y obstétricos. El manejo de estas fístulas se ha definido mejor y estandarizado en la última década. La reparación de la fístula vesico-vaginal frecuentemente se lleva a cabo a través de un abordaje transvaginal en el caso de las fístulas infratrigonales y mediante un abordaje abdominal transvesical para las fístulas supratrigonales. Presentamos un caso de fístula vesico-vaginal tras histerectomía que fue reparada mediante una abordaje laparoscópico. Vamos a describir una técnica novedosa para el tratamiento de fístula vesico-vaginal de ubicación supratrigonal por vía laparoscópica intraperitoneal (AU)


Vesicovaginal fístula is among the most distressing complications of gynaecological and obstetrical procedures. Management of these fístulas has been better defined and standardised over the last decade. Vesicovaginal fístula repair is most commonly repaired with transvaginal approach in cases of supratrigonal fístula and with abdominal approach in cases of supratrigonal fístula. We report a case of a vesicovaginal fístula after abdominal hysterectomy, which was repaired using a laparoscopic approach. The fístula followed a hysterectomy. We will describe a novel technique for the treatment of vesicovaginal fístula of supratrigonal location by intraperitoneal laparoscopic approach (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/cirurgia , Fístula Vesicovaginal , Laparoscopia/métodos , Histerectomia/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Cistoscopia/métodos , Vagina/cirurgia
14.
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
17.
Int Urogynecol J ; 28(4): 569-574, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27640063

RESUMO

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.


Assuntos
Cálculos da Bexiga Urinária/complicações , Fístula Vesicovaginal/complicações , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cálculos da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos , Fístula Vesicovaginal/cirurgia , Adulto Jovem
18.
Neurourol Urodyn ; 36(6): 1622-1628, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27794173

RESUMO

AIMS: To analyze patient characteristics, complications, and surgical trends in vesicovaginal fistulas (VVF) from a national database. METHODS: Current Procedural Terminology was used to identify patients undergoing VVF repair from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database. Characteristics and treatments were identified. Logistic regression was used to identify characteristics associated with complications. RESULTS: From 2006 to 2013, 200 patients underwent VVF repair. Mean age was 50.3 ± 12.3 years. A large proportion of patients were overweight (72%) and recent smokers (30%). Predominant comorbidities were heart disease (29%) and type 2 diabetes (9.5%). Of all VVF repairs, 65% were repaired vaginally. Concomitant procedures included hysterectomy (n = 6), reconstructive flaps (n = 13), and slings (n = 2). Post-operative complications occurred in 15% of patients. The most common complication was urinary tract infection (8%) followed by blood transfusion (3%). Compared to the vaginal approach, abdominal VVF repairs had higher overall morbidity (22% vs 7% P = 0.003), longer length of stay (3.5 ± 2.3 vs 1.6 ± 2 days P = 0.00) and were more likely to be associated with sepsis (4.3% vs 0% P = 0.02), blood transfusion (7.1% vs 0.8% P = 0.017), and readmission (10.1% vs 0.8% P = 0.003). In multivariate analysis, abdominal approach was a significant predictor of complications within 30 days (P = 0.03, P = 0.02). CONCLUSIONS: In the US VVF remains a rare entity. Over half of VVFs were repaired vaginally. The occurrence of serious complications is low. A vaginal approach appears to be associated with fewer complications.


Assuntos
Histerectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Fístula Vesicovaginal/cirurgia , Adulto , Idoso , Transfusão de Sangue , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/complicações , Feminino , Cardiopatias/complicações , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Infecções Urinárias/etiologia , Fístula Vesicovaginal/complicações
19.
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
20.
Midwifery ; 42: 54-60, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27769010

RESUMO

AIM: this study aimed to gain understanding of the views of community members in relation to obstetric fistula. DESIGN AND METHOD: a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data. SETTING: participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital. FINDINGS: the core category (central concept) is 'secrecy hinders support'. This was supported by three themes: 'keeping fistula hidden', 'treatment being a lottery' and 'multiple barriers to support.' These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered. CONCLUSIONS: A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research.


Assuntos
Acesso aos Serviços de Saúde , Complicações do Trabalho de Parto/psicologia , Qualidade de Vida/psicologia , Fístula Retovaginal/psicologia , Estigma Social , Fístula Vesicovaginal/psicologia , Adulto , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Quênia , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Uretra/lesões , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Adulto Jovem
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