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1.
Urologiia ; (6): 137-141, 2020 12.
Artigo em Russo | MEDLINE | ID: mdl-33377693

RESUMO

Urogenital fistulas in women are an urgent problem in modern urology, gynecology and surgery. Several decades earlier, iatrogenic damage was the main reason for their development. The aim of this review was to analyze the etiology, characteristics and results of treatment of fistulas in women in Russia and the CIS countries. A systematic analysis of the articles in the PubMed and eLibrary databases dedicated to etiology, treatment technique and postoperative results of treatment of urogenital fistulas in women was carried out. The results were compared with European data. A total of 16 articles were selected over a 20-year period that met the inclusion criteria. Iatrogenic injury resulted in the fistula formation in 40.54% (373/920) of cases. The majority of fistulas were caused by radiation therapy (58.91%, 542/920). According to the results, 84.02% (773/920) of fistulas were successfully healed. Cure rate of patients with post-radiation fistulas was 75.83% (411/542). Comparison of surgical techniques was difficult, since in most cases the preference of the surgeon was main determinant factor.


Assuntos
Urologia , Fístula Vesicovaginal , Feminino , Humanos , Idioma , Federação Russa , Resultado do Tratamento , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
2.
Urologe A ; 59(4): 432-441, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32270241

RESUMO

Vesicovaginal fistulas (VVF) represent a detrimental condition causing psychological, physical and social strain on patients. In developed countries they are predominantly the result of pelvic surgery or radiation therapy, whilst obstetric VVF are common in developing countries due to prolonged and complicated births. The majority of VVF require surgical therapy, thus a comprehensive diagnostic workup is needed. Depending on diagnostic characteristics fistula repair can be performed by a transvaginal, transabdominal or minimally invasive approach. Timing of surgery, appropriate interposition of vascularized grafts, optimized postoperative management and surgical expertise are determining factors for successful treatment. This review describes the diagnostic workup and therapeutic management of VVF including various surgical techniques.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urogenitais/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgia , Feminino , Humanos , Histerectomia , Retalhos Cirúrgicos , Fístula Vesicovaginal/etiologia
3.
Urologe A ; 59(4): 489-498, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32236687

RESUMO

Vesicovaginal fistulas are a rare problem in the western world but are frequent occurrences in developing countries. In Germany the most frequent cause is hysterectomy. Vesicovaginal fistulas can be treated by the transvaginal or transabdominal approach depending on the characteristics of the fistula and the patient. The incidence and complexity of urorectal fistulas increase with the number of cumulative sequences of prostate cancer treatment. Overall there is no clear consensus about the optimal surgical approach route. The surgical treatment of both vesicovaginal and urorectal fistulas is associated with high permanent fistula closure rates; however, for both entities if the fistula is discovered early enough, conservative treatment with a temporary catheter drainage can be tried, depending on the underlying cause. For both conditions fistula repair in irradiated patients shows a much lower success rate. A spontaneous closure of fistulas in radiogenic fistulas is also not to be expected.


Assuntos
Histerectomia/efeitos adversos , Neoplasias da Próstata/complicações , Fístula Retal/cirurgia , Procedimentos Cirúrgicos Operatórios , Fístula Vesicovaginal/cirurgia , Tratamento Conservador , Drenagem , Feminino , Alemanha , Humanos , Masculino , Fístula Retal/etiologia , Fístula Vesicovaginal/etiologia
4.
Trop Med Int Health ; 25(6): 687-694, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32223055

RESUMO

OBJECTIVE: To describe the frequency, causes and post-repair outcomes of NOF in hospitals supported by the Fistula Care Plus (FC+) project in the Democratic Republic of Congo. METHODS: Retrospective cohort study from 1 January 2015 to 31 December 2017 in three FC + supported fistula repair sites. RESULTS: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three FC + supported hospitals, 384 (19%) were considered to be non-obstetric fistula (NOF) cases. 49.3% were married/in a relationship at the time of treatment vs. 69% before the fistula, P < 0.001. Type III (n = 247; 64.3%) and type I (n = 121; 31.5%) fistulas according to Kees/Waaldijk classification were the most common. The main causes of NOF were medical procedure (n = 305; 79.4%); of these, caesarean section (n = 234; 76.7%) and hysterectomy (n = 54; 17.7%) were the most common. At hospital discharge, the fistula was closed and dry in 353 women (95.7%). CONCLUSION: Non-obstetric fistula, particularly due to iatrogenic causes, was relatively common in the DRC, calling for more prevention that includes improved quality of care in maternal health services.


Assuntos
Fístula Vesicovaginal/epidemiologia , Adolescente , Adulto , Cesárea/efeitos adversos , República Democrática do Congo/epidemiologia , Feminino , Humanos , Histerectomia/efeitos adversos , Pessoa de Meia-Idade , Paridade , Características de Residência , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia , Adulto Jovem
5.
Int J Gynaecol Obstet ; 148 Suppl 1: 33-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943186

RESUMO

OBJECTIVE: To analyze trends in iatrogenic urogenital fistula among patients admitted for fistula repair at the Pakistan Institute of Medical Sciences, Islamabad. METHODS: In this longitudinal study, all patients who presented for fistula repair between 2006 and 2018 were included in the study. Patient data were collected on age, parity, and type and etiology of fistula, which was classified as ischemic or iatrogenic. RESULTS: Of 634 fistula patients, 371 (58.5%) had iatrogenic fistula, while 263 (41.5%) patients developed ischemic fistula due to obstructed labor. Mean age of patients was 31.6 years. Yearly trends showed an increase in iatrogenic fistula from 43.2% in 2006-2008 to 71.4% in 2017-2018. The major etiological contributor to iatrogenic fistula was hysterectomy (52.5%), followed by cesarean hysterectomy (26.4%), and cesarean delivery (19.9%). CONCLUSION: A rising trend in iatrogenic fistula was observed. This emphasizes the need for optimization of surgical approaches and surgical skills. Moreover, gynecologic surgeries should be restricted to authorized gynecologic surgeons.


Assuntos
Cesárea/efeitos adversos , Histerectomia/efeitos adversos , Doença Iatrogênica/epidemiologia , Fístula Vesicovaginal/epidemiologia , Adulto , Feminino , Ginecologia/educação , Ginecologia/normas , Humanos , Estudos Longitudinais , Paquistão/epidemiologia , Gravidez , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
6.
BJOG ; 127(7): 897-904, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31961472

RESUMO

OBJECTIVE: To describe and compare baseline renal anatomy and renal function in patients with obstetric fistulas, and to evaluate whether preoperative renal testing and imaging may aid with operative decision making. DESIGN: A prospective cohort study. SETTING: Fistula Care Centre in Malawi. POPULATION: Women with an obstetric fistula. METHODS: Baseline creatinine testing and renal ultrasounds were performed. Surgeons completed a short questionnaire on the usefulness of creatinine and renal ultrasound on operative decision making. MAIN OUTCOME MEASURES: Baseline creatinine and renal ultrasound findings. RESULTS: Four surgeons performed operations on 85 patients. The mean creatinine in patients with vesicovaginal fistulas (VVF) was 0.60 ng/ml versus patients with uretero-vaginal fistulas (UVF) (0.79 ng/ml, P = 0.012). When a grade 3 or more hydronephrosis is absent on renal ultrasound, the negative predictive value of the presence of UVF is 93.3% (95% confidence interval [CI] 88.6-96.2) with a specificity of 97.2% (95% CI 90.3-99.6). In cases of UVF, surgeons found the renal ultrasound results useful or very useful 87.5% of the time, and the creatinine useful or very useful 75% of the time. CONCLUSION: In this pilot study, most patients with obstetric fistulas presented with a normal creatinine. In the absence of a grade 3 hydronephrosis or above on renal ultrasound, the probability of not having a UVF is 93.3%. Surgeons should consider performing preoperative renal ultrasound testing in all patients with an obstetric fistula, particularly in women with a prior laparotomy, as this population has risk factors for ureterovaginal fistula. TWEETABLE ABSTRACT: Most patients with obstetric fistulas have normal renal function. Preoperative renal ultrasounds should be performed.


Assuntos
Rim/diagnóstico por imagem , Complicações do Trabalho de Parto , Fístula Urinária , Fístula Vesicovaginal , Adulto , Feminino , Humanos , Testes de Função Renal/métodos , Malaui/epidemiologia , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Estudos Prospectivos , Melhoria de Qualidade , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Ultrassonografia/métodos , Fístula Urinária/diagnóstico , Fístula Urinária/epidemiologia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
7.
J Minim Invasive Gynecol ; 27(3): 580, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31352069

RESUMO

STUDY OBJECTIVE: To illustrate a technique of robotic vesicovaginal fistula repair in a patient with a previous history of pelvic radiation therapy and multiple abdominal surgeries. DESIGN: Stepwise demonstration of the technique with narrated video footage. SETTING: This 59-year-old woman presented with vesicovaginal fistula. She had a history of rectosigmoidectomy followed by pelvic radiotherapy for stage III colon cancer 23 years earlier and subsequent robotic hysterectomy, bilateral salpingo-oophorectomy, and omentectomy with bilateral pelvic and para-aortic lymphadenectomy for stage II mixed cell endometrial carcinoma, which required surgical reintervention because of a pelvic hematoma and complete vaginal cuff dehiscence. INTERVENTIONS: We performed a robotic approach to vesicovaginal fistula with several key steps to repair the fistula and maintain the integrity of the abdominopelvic structures: (1) careful bowel adhesiolysis involving multiple segments of the intestine to the abdominal and pelvic peritoneum; (2) cystotomy with vaginal probe guidance; (3) fistulectomy by monopolar scissors after ureteral orifice visualization; (4) dissection of the retropubic space of Retzius, relieving bladder tension; (5) transverse sutures to coapt the raw surfaces on the vaginal side and the bladder in 2 layers with minimal tension; and (6) transurethral instillation of methylene blue into the bladder. CONCLUSIONS: Traditionally, patients with vesicovaginal fistula after pelvic radiation therapy and multiple abdominal surgeries are managed by laparotomy. This video demonstrates a feasible robotic approach to vesicovaginal fistula repair, with superior imaging affording 3-dimensional visualization and stabilization of instruments, allowing wrist-like movements.


Assuntos
Cistostomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Fístula Vesicovaginal/cirurgia , Cavidade Abdominal/cirurgia , Feminino , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Pelve/efeitos da radiação , Peritônio/cirurgia , Radioterapia/efeitos adversos , Ureter/cirurgia , Fístula Vesicovaginal/etiologia
8.
Prog. obstet. ginecol. (Ed. impr.) ; 62(6): 567-569, nov.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-192144

RESUMO

El parto vaginal después de una cesárea segmentaria transversa anterior es considerado una alternativa segura y efectiva a la cesárea electiva si las condiciones obstétricas lo permiten. Una de las complicaciones más graves es la rotura uterina, la cual se asocia de forma inusual a rotura de vejiga urinaria. Se reporta un caso clínico de un parto vaginal acompañado de rotura uterina y de vejiga urinaria en tercigesta con cesárea anterior. En conclusión, en gestantes con cesárea anterior, con o sin sintomatología intraparto, se ha de considerar la asociación de rotura de la vejiga urinaria y uterina debida a la existencia de mayor riesgo de adherencias entre la pared anterior uterina y la vejiga urinaria. Ante hematuria posparto, siempre descartar rotura vesical. Se considera de alta importancia el consejo prenatal para recordar los riesgos implicados en gestantes que optan por un parto vaginal con cesárea anterior


Vaginal birth after a caesarean section is considered a safe and effective alternative to elective caesarean if obstetric conditions allow it. One of the most serious complications is uterine rupture, which is infrequently associated with bladder rupture. A clinical case of a vaginal birth associated to uterine and bladder rupture is reported in a multiparous with a previous caesarean section. In conclusion, in pregnant women with a previous caesarean section, with or without intrapartum symptoms, it has to be considered the association with bladder rupture and uterine rupture due to the mayor risk of adherences between the anterior uterine wall and the bladder. Against hematuria postpartum, always discard bladder rupture. It is considered of high importance the prenatal advice to remember the implicated risks in pregnant women who choose a vaginal birth with a previous caesarean


Assuntos
Humanos , Feminino , Adulto , Complicações do Trabalho de Parto , Nascimento Vaginal Após Cesárea/efeitos adversos , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/terapia , Cateteres Urinários
9.
J Med Case Rep ; 13(1): 330, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718672

RESUMO

BACKGROUND: Lithopedion is a word derived from the Greek words lithos, meaning stone, and paidion, meaning child, to describe a fetus that has become stony or petrified. Lithopedion is a rare complication of pregnancy which occurs when a fetus dies and becomes too large to be reabsorbed by the body. This entity in rare circumstances can be challenging for physicians to diagnose since it has a range of clinical manifestations. CASE PRESENTATION: We present a case of a 55-year-old, gravida IV para III, Ethiopian woman from Ethiopia with a retained fetus and vesicovaginal fistula after an obstructed labor and a neglected intrauterine fetal demise of approximately 22 years. The diagnosis was confirmed by suggestive clinical history, physical examination findings, and an abdominopelvic computed tomography scan. Laparotomy and removal of the lithopedion was done and our patient was sent to a fistula hospital for vesicovaginal fistula repair. CONCLUSION: This case is a rare phenomenon in which the dead fetus remained in the uterus for a long time after a neglected obstructed labor and uterine rupture.


Assuntos
Dor Abdominal/diagnóstico por imagem , Calcinose/patologia , Feto/patologia , Gravidez Abdominal/patologia , Fístula Vesicovaginal/cirurgia , Calcinose/diagnóstico por imagem , Feminino , Feto/diagnóstico por imagem , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Gravidez , Gravidez Abdominal/diagnóstico por imagem , Gravidez Abdominal/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vesicovaginal/etiologia
10.
Pan Afr Med J ; 33: 126, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558925

RESUMO

Vesicovaginal fistula (VVF) continues to be a major public health problem in developing countries. Given the particular association of VVF with stones, the question that arises is whether the fistula is primary or secondary to bladder stone and then whether to use single-stage or two-stage treatment. But what is special about this study is that these rare clinical features are due to tuberculosis. We here report the case of a 62-year old female patient with a history of treated tuberculous spondylodiscitis. The patient had been declared cured 4 years before. For the previous 2 years she had been suffering from continuous urinary incontinence. Clinical examination showed almost complete vaginal synechia. Complementary scannography and cystography showed the presence of 3 stones on the way to the VVF. The largest stone measured 6cm along its longer axis with passage of contrast material into the uterovaginal cavity through the fistula. The patient was admitted to the operating room where she underwent cystolithotomy with ablation of the stones that were on the way to the fistula, biopsy of the fistulous tract and single-stage closure of the VVF in two layers without interposition of the autologous tissue. Anatomopathological results confirmed the presence of active tuberculosis on the way to the fistula, requiring resumption of antibacillary treatment for 9 months. During the follow-up visit at 3, 6 and 9 months the patient showed good clinical status with absence of urinary incontinence. VVF secondary to tuberculosis associated with urinary stones appears very little in literature. Our case demonstrates the feasibility of antibacillar medical treatment associated with single-stage surgical treatment with very satisfactory results despite the history of our patient and the duration of his disease.


Assuntos
Tuberculose da Coluna Vertebral/diagnóstico , Cálculos da Bexiga Urinária/diagnóstico , Incontinência Urinária/etiologia , Fístula Vesicovaginal/diagnóstico , Antituberculosos/administração & dosagem , Biópsia , Discite/microbiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/tratamento farmacológico , Cálculos da Bexiga Urinária/patologia , Fístula Vesicovaginal/etiologia
11.
Pan Afr Med J ; 33: 133, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558932

RESUMO

This study aims to analyze the epidemiological, clinical, therapeutic and anatomopathologic features of urogenital fistulas. We conducted a retrospective study of patients with urogenital fistulas admitted to the department of general surgery and gynecology and obstetrics between January 1, 2014 and December 30, 2015, including the first 5 fistula repair campaigns organized by the Fistula Mali project. Urogenital fistulas account for 19.53% of all urologic disorder treated during our daily practice. The median age at first marriage was 16.57 years. The majority of our patients (96.70%) was illiterate and self-employed, coming from rural areas (85.36%). Obstructed labour was the dominant etiology, with 91.50% of stillborn children. The patients were primiparous women (43.33%) and, among them, 53.60% received no prenatal care. The divorce rate associated with the disease was 7.30%. Most patients underwent simple fistulorraphy, of whom 121 underwent lower fistulorraphy, 26 upper fistulorraphy and 3 mixed fistulorraphy. Outcomes were satisfactory in 65.33% patients and poor in 34.66% of patients. Patients with type I and type V obstetric fistulas had the highest healing rate compared to patients with type IV fistulas. Urogenital fistulas are a real public health problem. Treatment is mainly based on surgery and prognosis is compromised by the narrowness of the surgical field, the complexity of the lesions and the condition of the surrounding tissue. The focus must be on the implementation of women's socio economic development programs and on emergency obstetric care access. The research and discussion should continue to facilitate the development of a standard classification.


Assuntos
Complicações do Trabalho de Parto/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Fístula Vesicovaginal/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Mali , Pessoa de Meia-Idade , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia , Adulto Jovem
13.
Int J Urol ; 26(7): 717-723, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31206870

RESUMO

OBJECTIVES: To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula. METHODS: We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. RESULTS: Overall, 116 patients (median age 49 years, range 23-88 years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post-radiotherapy vesicovaginal fistula, and the remainder were post-surgical. Three patients with post-radiotherapy vesicovaginal fistula proceeded to primary diversion. CONCLUSIONS: Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Ureter/lesões , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Fístula Vesicovaginal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Incidência , Londres/epidemiologia , Pessoa de Meia-Idade , Reimplante , Estudos Retrospectivos , Doenças Ureterais/epidemiologia , Fístula Vesicovaginal/epidemiologia , Adulto Jovem
14.
Brachytherapy ; 18(4): 530-538, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31103434

RESUMO

PURPOSE: External beam radiotherapy combined with interstitial brachytherapy is commonly used to treat patients with bulky, advanced gynecologic cancer. However, the high radiation dose needed to control the tumor may result in fistula development. There is a clinical need to identify patients at high risk for fistula formation such that treatment may be managed to prevent this toxic side effect. This work aims to develop a fistula prediction model framework using machine learning based on patient, tumor, and treatment features. METHODS AND MATERIALS: This retrospective study included 35 patients treated at our institution using interstitial brachytherapy for various gynecological malignancies. Five patients developed rectovaginal fistula and two developed both rectovaginal and vesicovaginal fistula. For each patient, 31 clinical features of multiple data types were collected to develop a fistula prediction framework. A nonlinear support vector machine was used to build the prediction model. Sequential backward feature selection and sequential floating backward feature selection methods were used to determine optimal feature sets. To overcome data imbalance issues, the synthetic minority oversampling technique was used to generate synthetic fistula cases for model training. RESULTS: Seven mixed data features were selected by both sequential backward selection and sequential floating backward selection methods. Our prediction model using these features achieved a high prediction accuracy, that is, 0.904 area under the curve, 97.1% sensitivity, and 88.5% specificity. CONCLUSIONS: A machine-learning-based prediction model of fistula formation has been developed for patients with advanced gynecological malignancies treated using interstitial brachytherapy. This model may be clinically impactful pending refinement and validation in a larger series.


Assuntos
Braquiterapia/efeitos adversos , Neoplasias dos Genitais Femininos/radioterapia , Modelos Teóricos , Fístula Retovaginal/etiologia , Máquina de Vetores de Suporte , Fístula Vesicovaginal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Braquiterapia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
15.
BMC Womens Health ; 19(1): 37, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808352

RESUMO

BACKGROUND: Obstetric fistula is a hole between the vagina and bladder, and/or between the vagina and rectum, triggered by prolonged obstructed labor. The World Health Organization has estimated that at least 50,000 to 100,000 cases of obstetric fistula occur every year, and that over two million women with obstetric fistula in developing countries remain untreated. Research on women's lived experiences of obstetric fistula is limited. This study aimed to explore the lived experience of women with obstetric fistula at Bahir Dar Hamlin Fistula Center, Amhara Regional State, Ethiopia. METHODS: A qualitative study design, drawing from a phenomenological approach, was employed to explore the lived experience of purposively-selected sample of ten women with obstetric fistula. In-depth interviews were conducted in the local language (Amharic) using an interview guide. Interviews were transcribed and translated into English, and transcripts were entered as primary documents into Atlas.ti 7 software. Thematic categories were identified, and transcripts were coded accordingly. RESULTS: Participants perceived that the contributing factors to obstetric fistula were: instrument-assisted delivery; inappropriate physical examination and care; early marriage; and long duration of labour. As a result of obstetric fistula, the patients suffered from uncontrolled dripping of urine and/or faeces (and associated offensive odours), ostracization by their family and community members, and feeling hopeless and isolation from the community. Patients used different coping mechanisms, including frequent washing of clothes and changing of underwear; they also expressed that they preferred to be alone. CONCLUSION: Women with obstetric fistula experienced urine incontinence and associated bad odour; social and psychological problems like isolation, divorce and fears were commonly reported. Our findings from perspectives of Ethiopian setting suggest that integrated services for women with obstetric fistula are warranted, including physical therapy, psychological support and social reintegration.


Assuntos
Países em Desenvolvimento , Complicações do Trabalho de Parto/psicologia , Fístula Retovaginal/psicologia , Fístula Vesicovaginal/psicologia , Adulto , Divórcio , Etiópia , Incontinência Fecal/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Complicações do Trabalho de Parto/etiologia , Gravidez , Pesquisa Qualitativa , Fístula Retovaginal/etiologia , Autoimagem , Isolamento Social , Marginalização Social , Incontinência Urinária/etiologia , Fístula Vesicovaginal/etiologia
16.
BMC Womens Health ; 19(1): 5, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616532

RESUMO

BACKGROUND: Obstetric fistula is an abnormal connection between the vagina and rectum and/or bladder, which leads to continuous urinary or fecal incontinence. It is a serious problem in the world poorest countries, where most mothers give birth without any medical care. In most cases obstetric fistula is preventable and can be treated successfully, if it is carried out by a competent surgeon with a good follow-up of postoperative care. However, there remains to explore more on the duration of obstetric fistula recovery and determinant factors. The aim of this study was to estimate the average recovery time of obstetric fistula and to identify its determinants in Gondar University teaching and referral hospital, northwest Ethiopia. METHOD: A retrospective follow up study was conducted at Gondar University teaching and referral hospital. A total of 612 fistula cases were included in the study and simple random sampling technique was applied to select the study subjects. Kaplan-Meier and log rank test were computed to explore the data. Weibull regression survival model with univariate frailty was done to identify the determinant factors of time to recovery. RESULTS: Of 612 fistula patients, 539(88.07%) were recovered. The Average (median) recovery time was 5.14 (IQR = 3.14, 9.14) weeks. Using Antibiotic (AHR = 1.49, 95% CI = 1.11-2.01), having history of antenatal care (ANC) (AHR = 1.95, 95% CI = 1.39-2.73), being literate (AHR = 2.23, 95% CI = 1.62-3.06), duration of bladder catheterization (AHR = 0.93, CI = 0.90-0.95) and being multiparous (AHR = 1.51, 95% CI = 1.17-1.96) were a significant predictors of the rate of recovery. Also, underweight (AHR = 0.45, 95% CI = 0.30-0.68), overweight (AHR = 0.56, 95% CI = 0.41-0.76), being obese (AHR = 0.41, 95% CI = 0.21-0.80), having extensive fistula (AHR = 0.82, 95% CI = 0.73-0.91), large fistula (AHR = 0.42, 95% CI = 0.23-0.78), medium width (AHR = 0.62, 95% CI = 0.43-0.91) and large width (AHR = 0.42, 95% CI = 0.23-0.78) were statistically significant predictors of the rate of recovery from fistula patients. CONCLUSION: The average recovery time from obstetric fistula patients was 5.14 weeks. Small Length and width of fistula, patients' educational status (literacy), antibiotic use, history of antenatal care visits, normal BMI, short period catheterization and being multiparous were the significant determinate variables which shorten the recovery time of obstetric fistula.


Assuntos
Complicações do Trabalho de Parto/terapia , Cuidado Pré-Natal/métodos , Recuperação de Função Fisiológica , Fístula Vesicovaginal/terapia , Adulto , Etiópia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Fístula Vesicovaginal/etiologia
17.
Taiwan J Obstet Gynecol ; 58(1): 111-116, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30638463

RESUMO

OBJECTIVE: Vesicovaginal fistulas (VVF) are consequences from obstetric and gynecologic surgery. Treatment approach from either abdominal or vaginal route have its own pros and cons. The study aims to present the anatomical, clinical and lower urinary tract symptom outcomes of women with VVF. MATERIALS AND METHODS: A retrospective case series conducted patients with VVF. Data regarding pre-operative evaluation, surgical treatment, and post-operative follow-ups were collected. Surgical approach depended on the cause, type, number, size, location, and time of onset of the fistula. Post-operatively, foley catheter was maintained for at least 1 week with cystoscopy performed prior to removal. Follow-up evaluation included cystoscopy, bladder diary, UDI-6 and IIQ-7 questionnaires and multi-channel urodynamic study. RESULTS: Of the 15 patients that were evaluated, 1 had spontaneous closure, 8 were repaired vaginally and 6 abdominally. Patients repaired vaginally were significantly noted to have a mean age of 50.3 ± 7.1 years with VVFs located adjacent the supra-trigone area having a mean distance of 1.7 ± 0.5 cm from the ureteric orifice. Its operative time and hospital stay were significantly shorter. In contrast, abdominally repaired patients had mean age of 38.0 ± 8.2 years and VVFs with mean distance of 0.4 ± 0.4 cm from the ureteric orifice. Post-operatively, 2 cases (14.2%, 2/14) of VVF recurrence and de novo urodynamic stress incontinence (USI) (25%, 2/8) were noted after vaginal repair and 3 cases (50%, 3/6) of concurrent ureteric injury and overactive bladder after abdominal repair. CONCLUSION: Treatment outcomes for vaginal and abdominal repair yielded good results. Though the vaginal route had higher incidence of recurrence and de novo USI, its less invasiveness, faster recovery period, and no association with post-op overactive bladder made it more preferable than the abdominal approach.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/patologia
18.
Urol Clin North Am ; 46(1): 123-133, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466697

RESUMO

Vesicovaginal fistula is the most commonly encountered sequela of genitourinary trauma. Although the etiology differs between developed and developing countries, the principles of fistula repair must be strictly adhered to for success. Timing and route of repair remain contentious, because of a lack of randomized data. Evaluation and management is dictated by the surgeon's experience. Minimally invasive techniques with laparoscopy and robotic technology are generating wider interest with reduced postoperative morbidity, but a transvaginal technique should be in the arsenal of all pelvic reconstructive surgeons. More research is required to evaluate the optimal surgical route and technique for successful outcomes.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Fístula Vesicovaginal/cirurgia , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Fatores de Risco , Vagina/cirurgia , Fístula Vesicovaginal/etiologia
19.
Urol Clin North Am ; 46(1): 135-146, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466698

RESUMO

Principles of abdominal vesicovaginal fistula (VVF) repair include good exposure of the fistulous tract, double-layer bladder closure, retrograde fill of the bladder to ensure a water-tight seal, tension-free closure and continuous postoperative bladder drainage. Minimally invasive approaches, particularly robot-assisted laparoscopy, have demonstrated shorter operative times, decreased blood loss, improved visibility, and similar cure rates without increased adverse events. These techniques are therefore rising in popularity among surgeons. Ultimately, surgical approach to VVF repair depends upon the individual characteristics of the patient and fistula, as well as the preference and experience of the surgeon.


Assuntos
Abdome/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Laparoscopia , Duração da Cirurgia , Robótica , Fístula Vesicovaginal/etiologia
20.
Int Urogynecol J ; 30(2): 327-329, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30564873

RESUMO

OBJECTIVE: The objective of this video is to demonstrate a technique for robot-assisted vesicovaginal fistula (VVF) repair utilizing a mini cystotomy with a transvesical approach. METHODS: A 53-year-old female developed a VVF after she underwent an abdominal hysterectomy for uterine fibroids at an outside facility. She was referred to us following two failed VVF repairs (one vaginal, one abdominal with bladder bivalving and omental flap). After discussing options, she underwent a robotic VVF repair via a transvesical approach. Following port placement, the space of Retzius was mobilized. An intentional cystotomy was made and the camera and working arms advanced into the bladder. The fistula was identified and circumferentially mobilized. The fistula was closed in three layers using absorbable sutures, and care was taken to avoid the ureters. RESULTS: The patient's postoperative recovery was uncomplicated. Follow-up imaging was performed via cystogram at 4 weeks and showed resolution of the fistula. CONCLUSIONS: A robot-assisted transvesical approach using a mini cystotomy to VVF repair is a useful technique especially when previous surgical planes have been used in prior repairs and failed. It maintains a minimally invasive approach and may avoid complications associated with an open abdominal approach.


Assuntos
Cistotomia/métodos , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Fístula Vesicovaginal/etiologia
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