scholarly journals Pubococcygeal Sling versus Refixation of the Pubocervical Fascia in Vesicovaginal Fistula Repair: A Retrospective Review

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Rachel Pope ◽  
Prakash Ganesh ◽  
Jeffrey Wilkinson
Keyword(s):  
Residual Stress ◽  
Stress Incontinence ◽  
Vesicovaginal Fistula ◽  
Primary Outcome ◽  
Obstetric Fistula ◽  
Urinary Stress Incontinence ◽  
Fistula Repair ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Continence Status

Urethral incontinence is an issue for approximately 10–15% of women with an obstetric fistula. Various surgical interventions to prevent this exist, including the pubococcygeal sling and refixation of the pubocervical fascia. Neither has been evaluated in comparison to one another. Therefore, this retrospective evaluation for superiority was performed. The primary outcome was urinary stress incontinence, and secondary outcomes were operative factors. There were 185 PC slings, but 12 were excluded because of urethral plications. There were 50 RPCF procedures, but 3 were excluded because of urethral plications. Finally, there were 32 cases with both PC sling and RPCF procedures. All groups demonstrated a higher than expected fistula repair rate with negative dye tests in 84% of the PC sling group, 89.9% in the RPCF group, and 93.8% in the RPCF and PC groups. There were no statistically significant differences found in continence status between the three groups. Of those who underwent PC slings, 49% were found to have residual stress incontinence. Of those who underwent RPCF, 47.8% had stress incontinence. Of those with both techniques, 43.8% had residual stress incontinence. Pad weight was not significantly different between the groups. As there is no statistically significant difference, we cannot recommend one procedure over the other as an anti-incontinence procedure. The use of both simultaneously is worth investigating.

Association Between Urinary Stress Incontinence and Levator Avulsion Detected by 3D Transperineal Ultrasound

2021 ◽  
Author(s):  
Chunyan Zhong ◽  
Pan Hu ◽  
Suzhen Ran ◽  
Jing Tang ◽  
Chunmei Xiao ◽  
...  
Keyword(s):  
Stress Incontinence ◽  
Odds Ratio ◽  
Valsalva Maneuver ◽  
Urinary Stress Incontinence ◽  
Transperineal Ultrasound ◽  
Levator Hiatus ◽  
Levator Avulsion ◽  
Significant Difference ◽  
Standard Interview ◽  
Ultrasound Features

Abstract Purpose To determine the association between levator avulsion and urinary stress incontinence (USI) by 3/4D transperineal ultrasound. Materials and Methods 842 patients who were admitted to our hospital from 2016 to 2019 were recruited for our study. 3D/4D transperineal ultrasound was performed. After standard interview and clinical evaluation, general conditions and levator hiatus data were collected and measured to compare with each group. The odds ratio (OR) of USI symptoms or ultrasound features with levator avulsion were calculated. Results A total of 593 women were studied: 204 suffered from levator avulsion (96 cases of left-side avulsion, 80 cases of right-side avulsion and 28 cases of bilateral avulsion) and 389 women had no avulsion. The gravidity and episiotomy conditions of the avulsion groups were significantly different from the no-avulsion group. Significant differences were found in the transverse diameters and anteroposterior diameters between the levator avulsion group and the no-avulsion group, but there was no difference among the avulsion groups, regardless of whether the patient was at rest or performing the Valsalva maneuver. Interestingly, a significant difference was found in the presence of USI symptoms between the uni-avulsion group and the no-avulsion group. The odds ratio (OR) of USI symptoms in the uni-avulsion group is 2.786 (95 %CI, 1.663–4.669), but 0.939 (95 %CI, 0.276–3.199) for the bilateral avulsion and no-avulsion groups. Conclusion Unilateral levator avulsion may be a risk factor for urinary stress incontinence.

scholarly journals Factors Influencing Post-Operative Short-Term Outcomes of Vesicovaginal Fistula Repairs in a Community Hospital in Liberia

2011 ◽  
Vol 4 (6) ◽  
pp. 259-265 ◽  
Author(s):  
Oxana Munoz ◽  
C. Bryce Bowling ◽  
Kimberly A. Gerten ◽  
Rebecca Taryor ◽  
Andy M. Norman ◽  
...  
Keyword(s):  
Vesicovaginal Fistula ◽  
Primary Outcome ◽  
Community Dwelling ◽  
Success Rates ◽  
Short Term ◽  
Factors Influencing ◽  
Continence Status ◽  
The Mean ◽  
Continence Rate ◽  
First Time

Objectives: To assess factors influencing short-term outcomes of vesicovaginal fistula (VVF) repairs in community-dwelling women of Liberia, Africa. Methods: Forty patients who underwent VVF repairs were analyzed. Primary outcome was continence status at 14 days post repair. Factors influencing continence status were characterized. Results: The mean duration of leakage was 9.6 ±8.3 years, (3 months–28 years). Thirteen (33%) had previous repairs, and 6 (15%) had multiple fistula sites. Twenty-eight (70%) were continent at catheter removal. First time repairs had a higher continence rate compared to women with previous repairs, 78% and 54% respectively ( p = 0.15). Seven (47%) juxtaurethral repairs were considered failures, while only one (9%) juxtacervical fistula remained incontinent ( p =0.069). Controlling for duration of leakage, women with previous repairs were significantly less likely to be continent ( p = 0.04; adjusted OR = 0.07; 95% CI: 0.005, 0.83). Conclusions: Patients with previous VVF repairs and juxtaurethral fistulae experience lower success rates; surgery remains an effective treatment for many VVF patients.

scholarly journals Depression after Obstetric Fistula Repair

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Mary Stokes ◽  
Jeffrey Wilkinson ◽  
Prakash Ganesh ◽  
William Nundwe ◽  
Rachel Pope
Keyword(s):  
Mental Health ◽  
Obstetric Fistula ◽  
Age Group ◽  
Fistula Repair ◽  
Symptoms Of Depression ◽  
Persistent Depression ◽  
Continence Status ◽  
Operative Assessment ◽  
Over Time

Aims: To measure depression using the PHQ-9 over time and to identify characteristics associated with persistent depression. Methods: A database of women undergoing obstetric fistula repair was used to examine association of depression with variables such as general demographics, type of obstetric fistula, surgical outcome, and continence status at the time of discharge. Results: 797 patients completed the PHQ-9 upon initial pre-operative assessment. 365 (45.8%) had a PHQ-9 score of 5 or higher, indicating symptoms of depression. Pre-operatively, depression was associated with the 18-34 year old age group and women with no children. Post-operatively, worse incontinence was associated with depression, however, over time depression was rarely found among women returning for follow-up. Conclusions: The decrease of depression seen over time is either due to selection bias or due to improved adjustment to one’s circumstances. Either way, this study underscores the need for ongoing follow-up, perhaps especially for those not presenting. Further studies are needed to assess the mental health of women who do not present for follow-up visits.

scholarly journals Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital

2018 ◽  
Vol 13 (2) ◽  
pp. 19-22
Author(s):  
Ranjana Shrestha ◽  
Aruna Karki ◽  
Ganesh Dangal ◽  
Hema Pradhan ◽  
Kabin Bhattachan ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Obstetric Fistula ◽  
Sexual Life ◽  
Successful Outcome ◽  
Urinary Continence ◽  
Vaginal Fistula ◽  
Fistula Repair ◽  
Fistula Surgery ◽  
Prolonged Labor ◽  
Vesico Vaginal Fistula

Aims: Vesico-vaginal fistula (VVF) is an abnormal fistulous communication between the bladder and/or urethra and the vagina that allows continuous involuntary discharge of urine into the vaginal vault affecting patients’ medical, physical, mental, social and sexual life. The aim of this study was to review and deliver a profile, their demography and outcome in the early phase of fistula surgery performed in our institute. Methods: This was a retrospective study of 222 patients who underwent fistula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The fistula were classified according to Goh`s system.  Patients’ demography, obstetric characteristics and fistula repair outcomes were reviewed. The primary outcome was in terms of urinary continence. Results: A total of 222 women aged between 10 to 65 years with a mean age of 31.4 were included. Majority of the patients had fistula due to obstetrical cause, contributing 58% (n=127) and in 42 % (n=95) of patients had fistula of gynecological etiology. Most of the patients had fistula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh’s classification. Among 127 fistulas repaired of obstetric etiology100 (78.7%) patients and 85 (89.4%) out of 95 fistula patients of gynecological cause were continent and dry. Conclusions:  Our study showed obstructed and prolonged labor was the major cause of obstetric fistula, however iatrogenic fistula was also becoming common. Majority of our cases had successful outcome with some degree of stress in some patients.

scholarly journals Vesicovaginal Fistula (VVF): Success of primary repair.

2019 ◽  
Vol 26 (12) ◽  
pp. 2090-2094
Author(s):  
Robina Ali ◽  
Ghazala Niaz ◽  
Riffat Ehsan
Keyword(s):  
Vesicovaginal Fistula ◽  
Obstetric Fistula ◽  
Primary Repair ◽  
Tertiary Care ◽  
Home Delivery ◽  
Care Hospital ◽  
Fistula Repair ◽  
Operative Care ◽  
Ureteric Orifice ◽  
Quasi Experimental

Objectives: The main objective of this research is to determine success of primary repair of vesicovaginal fistula at tertiary care hospital. Study Design: Quasi Experimental. Setting: DHQ Hospital, Faisalabad, Obstetrics and Gynaecology Department. Period: From Mar 2015 to Mar 2017. Material & Method: 15 patients were enrolled by consecutive sampling and those having fistulas more than 4cm or involving ureteric orifice, bladder neck or urethra were excluded. After proper history examination, preliminary investigations and EUA, fistula repair was done. All information recorded on proposed proforma for this purpose. Results: Among all 15 patients, 10(66.7%) were having obstetric fistulas and 5(33.3%) were with non obstetric fistula. 07 (46.7%) had home delivery, 3(20%) had delivery at center by untrained persons, 3(20%) had hysterectomy by untrained surgeons i.e. 1(6.7%) for endometriosis, 1(6.7%) for multiple fibroids and 1(6.7%) for ovarian malignancy while 2(13.3%) patients had inducted miscarriages by midwives. 12 (80%) patients had subtrigonal and trigonal fistulas, so underwent transvaginal repair and rest 3(20%) had supratrigonal fistula so transabdominal repair was done. Success of repair was 93.3% (14) and 1 was complicated with failed fistula repair. Conclusion: Most fistulas encountered in this study were caused by obstetrics trauma and are preventable. In existing cases of vesicovaginal fistula, properly trained health professionals with impeccable evaluation, prudent decision about route and technique of repair and good post operative care are key points in success of surgical repair.  

scholarly journals Living with obstetric fistula for ten years: a delayed diagnosis and review of pertinent surgical technique

2021 ◽  
Vol 8 (2) ◽  
pp. 126-130
Author(s):  
Atit Poudel ◽  
Ganesh Dangal
Keyword(s):  
Caesarean Section ◽  
Surgical Technique ◽  
Vesicovaginal Fistula ◽  
Obstetric Fistula ◽  
Delayed Diagnosis ◽  
Fistula Repair ◽  
Common Cause ◽  
Transvaginal Approach ◽  
Obstructed Labour ◽  
Martius Flap

Obstructed labour is a common cause of vesicovaginal fistula in the developing world. Those fistulae occurring after labour and its complications is called obstetric fistula. We report a case of complex obstetric fistula in a 32 y woman who was having continuous leakage of urine since last 10 y following caesarean section for obstructed labour. A successful fistula repair was done with transvaginal approach with Latzko technique and interposition with Martius flap.

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