scholarly journals Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christl Reisenauer ◽  
Bastian Amend ◽  
Claudius Falch ◽  
Harald Abele ◽  
Sara Yvonne Brucker ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Developed Countries ◽  
Vaginal Wall ◽  
Fistula Closure ◽  
Fistula Repair ◽  
Anterior Position ◽  
Multiparous Women ◽  
Uncommon Condition ◽  
Rectovaginal Fistulas ◽  
Vesicovaginal Fistulas

Abstract Background Obstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre. Methods Women who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified, and their records were reviewed retrospectively. Results Eleven out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort, genitourinary fistulas were more common in multiparous women (9/11), and rectovaginal fistulas were more common in primiparous women (24/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina, and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65% of cases. Women who suffered from rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended fistula repair in the context of a subsequent delivery. For the first time, pregnancy-related changes in the vaginal wall were used to optimize the success rate of fistula closure. Conclusions In developed countries, birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, management must be tailored to the underlying pathology and the surgeon’s experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Although vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient, and a vesicovaginal fistula should be ruled out. Trial registration Retrospectively registered, DRKS 00022543, 28.07.2020.

scholarly journals Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

2020 ◽  
Author(s):  
Christl Reisenauer ◽  
Bastian Amend ◽  
Claudius Falch ◽  
Harald Abele ◽  
Sara Yvonne Brucker ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Developed Countries ◽  
Vaginal Wall ◽  
Fistula Closure ◽  
Fistula Repair ◽  
Anterior Position ◽  
Uncommon Condition ◽  
Rectovaginal Fistulas ◽  
Vesicovaginal Fistulas ◽  
First Time

Abstract Background: Obstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre.Methods: Women who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified and their records were reviewed retrospectively.Results: 11 out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort the genitourinary fistulas were more common in multiparous (9/11) and the rectovaginal fistulas in primiparaous women (24/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65%. Women who suffered from rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended the fistula repair in context of a subsequent delivery. For the first time, pregnancy related changes of the vaginal wall were used to optimize the success rate of a fistula closure.Conclusions: In developed countries, the birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, their management has to be tailored to the underlying pathology and the surgeonʼs experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Even if vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient and a vesicovaginal fistula should be ruled out.Trial registration: retrospectively registered, DRKS 00022543, 28.07.2020

scholarly journals Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

2020 ◽  
Author(s):  
Christl Reisenauer ◽  
Bastian Amend ◽  
Claudius Falch ◽  
Harald Abele ◽  
Sara Yvonne Brucker ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Developed Countries ◽  
Vaginal Wall ◽  
Fistula Repair ◽  
Anterior Position ◽  
Multiparous Women ◽  
Uncommon Condition ◽  
Rectovaginal Fistulas ◽  
Vesicovaginal Fistulas ◽  
First Time

Abstract BackgroundObstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre.MethodsWomen who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified, and their records were reviewed retrospectively.ResultsEleven out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort, genitourinary fistulas were more common in multiparous women (9/11), and rectovaginal fistulas were more common in primiparous women (24/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina, and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65% of cases. For women with rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended fistula repair in the context of a subsequent delivery. For the first time, pregnancy-related changes in the vaginal wall were used to optimize the success rate of fistula closure.ConclusionsIn developed countries, birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, management must be tailored to the underlying pathology and the surgeon’s experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Although vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient, and a vesicovaginal fistula should be ruled out.Trial registrationretrospectively registered, DRKS 00022543, 28.07.2020

scholarly journals Closure of large vesicovaginal fistulas by transplantation of the bladder wall

2020 ◽  
Vol 6 (4) ◽  
pp. 422-423
Author(s):  
A. Brandt
Keyword(s):  
Urinary Bladder ◽  
Pelvic Floor ◽  
Bladder Wall ◽  
Vaginal Wall ◽  
Vesicovaginal Fistulas

With large defects in the bottom of the urinary bladder, extensive adhesions of the edges of the fistulas directly with the bony walls of the pelvic floor, or with fixation of the uterus posteriorly, resp. to the sides, as well as in the absence of the anterior lip of the vaginal part or the lower part of the uterus with an existing utero-cystic fistula, it is possible to use the Trendelenburg method to close the defects, transplant a flap from the opposite fistula of the vaginal wall, or release the bladder over a large extent from surrounding parts and apply for transplantation of the wall of the urinary bladder itself.

Possibilities of using neodymium laser (Nd:YAG) in patients with concomitant diseases which are accompanied by pathological discharge from the genital tract

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 75-81
Author(s):  
Olga A. Pauzina ◽  
Inna A. Apolikhina ◽  
Darya A. Malyshkina
Keyword(s):  
Drug Therapy ◽  
Pelvic Floor ◽  
Genital Tract ◽  
Vaginal Discharge ◽  
Muscle Tone ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Vaginal Wall ◽  
Neodymium Laser ◽  
Frequent Relapses

Background. Pathological vaginal discharge is the most common disorder in women after giving birth who have vaginal relaxation syndrome and vaginal wall prolapse, as well as in women during menopause. To date, there are no clear treatment regimens for mixed vulvovaginal infections, and the use of only drug therapy in patients with pelvic organ prolapse and genitourinary syndrome of menopause in combination with diseases which are accompanied by pathological vaginal discharge does not give a long lasting result and is characterized by frequent relapses. In this regard, the use of laser methods in combination with drug therapy may lead to the recovery of vaginal microbiocenosis and a decrease in the number of relapses of diseases which are accompanied by pathological discharge from the genital tract. Results. Description. This article presents a clinical case and description of the experience of using a neodymium laser for the treatment of a patient with recurrent mixed vulvovaginitis, 2nd- degree vaginal wall prolapse, loss of pelvic floor muscle tone, vaginal relaxation syndrome and sexual dysfunction using neodymium laser. The woman received 3 procedures of exposure to a neodymium laser with an interval of 2830 days. After 3 procedures of exposure to a neodymium laser, the patient has a good clinical efficacy in the recovery of vaginal microbiocenosis. Conclusions. An innovative technique of exposure to Nd:YAG neodymium laser in the practice of a gynecologist has shown high clinical efficiency in the treatment of not only pelvic floor dysfunction, but also mixed vulvovaginitis. And, despite this aspect of the use of laser technologies requires further study, we can use a neodymium laser in combination with traditional drug therapy to treat diseases which are accompanied by pathological discharge from the genital tract in cases of ineffective drug monotherapy and frequent relapses.

scholarly journals Effect of Paula exercise method on functional outcomes of women with post fistula repair incontinence: a protocol for randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saratu Umar Aliyu ◽  
Shmaila M. Hanif ◽  
Isa Usman Lawal
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Randomized Controlled Trial ◽  
Pelvic Floor ◽  
Controlled Trial ◽  
Fistula Repair ◽  
Randomized Controlled ◽  
Urine Leakage ◽  
Pelvic Floor Strength

Abstract Background Post-fistula-repair incontinence (PFRI) is a common complication of vesicovaginal fistula (VVF) surgeries. It entails continuous leakage of urine after successful VVF closure. Pelvic Floor Muscle Training (PFMT) plays a vital role in the management of PFRI, however, an evolving exercise approach is the Paula Exercise Method (PEM) which has shown a promising effect in stopping urinary incontinence, but there is no data on its effect on PFRI. This study therefore, proposes to primarily investigate the effect of PEM on urine leakage and secondarily, pelvic floor strength (PFS), quality of life (QoL), sexual function (SF), and mental health (MH) in women with PFRI. Methods This is a study protocol for a randomized controlled trial. A total of 182 participants are expected to participate in the study after satisfying the inclusion criteria. The participants will be randomized into either PEM or PFMT study groups. The demographic data of all the participants will be recorded. Each participant will be assessed for urine leakage, PFS, QoL, SF, and MH at baseline and subsequently, at four, eight and 12 weeks of intervention. Demographic parameters will be summarized using descriptive statistics. Continuous data will be computed for differences using inferential statistic of Analysis of variance, t-test and Man Whitney U as appropriate. All analyses will be performed using SPSS version 22.0 with probability set at 0.05 alpha level. Discussion It is hoped that the outcome of this study will determine the effect of the Paula exercise method on urine leakage, pelvic floor strength, quality of life, sexual function, and mental health among women with post-fistula-repair incontinence and also provide evidence for the use of the Paula method in urinary incontinence. Trial registration: Pan African Clinical Trials Registry (www.pactr.org), identifier PACTR201906515532827.

Childbirth trauma

2020 ◽  
pp. 727-742
Author(s):  
Stergios Doumouchtsis
Keyword(s):  
Pelvic Floor ◽  
Anal Sphincter ◽  
Well Being ◽  
Anal Sphincter Injury ◽  
Nulliparous Women ◽  
Childbirth Trauma ◽  
Multiparous Women ◽  
Short And Long Term ◽  
Tissue Rupture ◽  
Nerve Muscle

Pelvic floor disorders are strongly associated with childbirth and are more prevalent in parous women. Pelvic floor trauma commonly occurs at the time of the first vaginal childbirth. Conventionally, childbirth trauma refers to perineal and vaginal trauma following delivery and the focus has been on the perineal body and the anal sphincter complex. However, childbirth trauma may involve different aspects of the pelvic floor. Pelvic floor trauma during vaginal childbirth may involve tissue rupture, compression, and stretching, resulting in nerve, muscle, and connective tissue damage. Some women may be more susceptible to pelvic floor trauma than others due to collagen weakness. Childbirth trauma affects millions of women worldwide. The incidence of perineal trauma is over 91% in nulliparous women and over 70% in multiparous women. A clinical diagnosis of obstetric anal sphincter injury (OASIS) is made in between 1% and 11% of women following vaginal delivery. Increased training and awareness around OASIS is associated with an increase in the reported incidence. Short- and long-term symptoms of childbirth trauma can have a significant effect on daily activities, psychological well-being, sexual function, and overall quality of life.

scholarly journals Development of anatomically based customizable three-dimensional finite-element model of pelvic floor support system: POP-SIM1.0

2019 ◽  
Vol 9 (4) ◽  
pp. 20190022 ◽  
Author(s):  
Mark T. Gordon ◽  
John O. L. DeLancey ◽  
Aaron Renfroe ◽  
Andrew Battles ◽  
Luyun Chen
Keyword(s):  
Finite Element ◽  
Magnetic Resonance ◽  
Pelvic Floor ◽  
Support System ◽  
Structural Parameters ◽  
Vaginal Wall ◽  
Abdominal Pressure ◽  
Fe Model ◽  
Vaginal Length ◽  
Pelvic Floor Support

To develop an anatomically based customizable finite-element (FE) model of the pelvic floor support system to simulate pelvic organ prolapse (POP): POP-SIM1.0. This new simulation platform allows for the construction of an array of models that objectively represent the key anatomical and functional variation in women with and without prolapse to test pathomechanism hypotheses of the prolapse formation. POP-SIM1.0 consists of anatomically based FE models and a suite of Python-based tools developed to rapidly construct FE models by customizing the base model with desired structural parameters. Each model consists of anatomical structures from three support subsystems which can be customized based on magnetic resonance image measurements in women with and without prolapse. The customizable structural parameters include presence of levator ani (LA) avulsion, hiatus size, anterior vaginal wall dimension, attachment fascia length and apical location in addition to the tissue material properties and intra-abdominal pressure loading. After customization, the FE model was loaded with increasing intra-abdominal pressure (0–100 cmH 2 O) and solved using ABAQUS explicit solver. We were able to rapidly construct anatomically based FE models with specific structural geometry which reflects the morphology changes often observed in women with prolapse. At maximum loading, simulated structural deformations have similar anatomical characteristics to those observed during clinical exams and stress magnetic resonance images. Simulation results showed the presence of LA muscle avulsion negatively impacts the pelvic floor support. The normal model with intact muscle had the smallest exposed vaginal length of 11 mm, while the bilateral avulsion produced the largest exposed vaginal length at 24 mm. The unilateral avulsion model had an exposed vaginal length of 18 mm and also demonstrated a tipped perineal body similar to that seen in clinical observation. Increasing the hiatus size, vaginal wall length and fascia length also resulted in worse pelvic floor support, increasing the exposed vaginal length from 18 mm in the base model to 33 mm, 54 mm and 23.5 mm, respectively. The developed POP-SIM1.0 can simulate the anatomical structure changes often observed in women with prolapse. Preliminary results showed that the presence of LA avulsion, enlarged hiatus, longer vaginal wall and fascia length can result in larger prolapse at simulated maximum Valsalva.

Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence

2018 ◽  
Vol 29 (11) ◽  
pp. 1661-1667 ◽  
Author(s):  
Jeffrey S. Schachar ◽  
Hemikaa Devakumar ◽  
Laura Martin ◽  
Sara Farag ◽  
Eric A. Hurtado ◽  
...  
Keyword(s):  
Risk Factor ◽  
Pelvic Floor ◽  
Muscle Weakness ◽  
Pelvic Floor Muscle ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Anterior Vaginal Wall Prolapse ◽  
Prolapse Recurrence ◽  
Pelvic Floor Muscle Weakness
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