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.

Vesicovaginal Fistula Repair by Modified Martius Flap: A Step-by-Step Surgical Technique Video

2020 ◽  
Author(s):  
Tiermes Marina ◽  
Víctor Lago ◽  
Pablo Padilla ◽  
Luis Matute ◽  
Santiago Domingo
Keyword(s):  
Surgical Technique ◽  
Vesicovaginal Fistula ◽  
Fistula Repair ◽  
Martius Flap

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.

Surgical Approach to Obstetric Fistula Repair in Niamey, Niger: A Description of Surgical Technique

2011 ◽  
Vol 01 (01) ◽  
Author(s):  
Elisabeth. A. Erekson ◽  
Brittany. S. Hampton ◽  
Abdoulaye Idrissa
Keyword(s):  
Surgical Technique ◽  
Surgical Approach ◽  
Obstetric Fistula ◽  
Fistula Repair

scholarly journals Outcome of Vesicovaginal Fistula Repair at Urology Department STH Swat

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Nizamuddin . ◽  
Fazal Elahi ◽  
Mumtaz Ali ◽  
Fazli Akbar ◽  
Mohammad Hussain ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Success Rate ◽  
Vesicovaginal Fistula ◽  
Abdominal Hysterectomy ◽  
Teaching Hospitals ◽  
Fistula Repair ◽  
Obstructed Labour ◽  
Urinary Tract Symptoms ◽  
Tract Infections ◽  
Lower Urinary

Background: Vesicovaginal fistula is an abnormal passage between the bladder and the vagina , which leads to continuous , involuntary loss of urine through the vagina. It is the most usual type of acquired genitourinary fistulas.Objective: To determine outcomes of vesicovaginal fistula repair at Urology Department, Saidu Teaching Hospital, Swat.Material and Methods: This descriptive study was conducted in Department of Urology, Saidu Group of Teaching Hospitals, Swat from September, 2016 to February, 2019. Patients with age group of 25-65 years, diagnosed with VVF were repaired either through abdominal or vaginal route. These patients were prospectively analysed and the demographic profile, route of surgery and outcomes were noted down.Results: A total of 58 patients were included in the study. The causes were obstructed labour in 26 patients, post-operative trans abdominal hysterectomy and caesarean section in 24 and 6 cases respectively. There was 100% success rate in abdominal repairs as compared to combined approach. Among the post-operative complications, bladder storage dysfunction was on the top, followed by urinary tract infections and wound infections.Conclusion: The most common cause of VVF was prolonged obstructed labour. Overall, the success rate was 96.5%. Irritative lower urinary tract symptoms were most commonly observed post operatively.

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 A nine-year review of medicolegal claims in neurosurgery

2014 ◽  
Vol 96 (4) ◽  
pp. 266-270 ◽  
Author(s):  
S Mukherjee ◽  
C Pringle ◽  
M Crocker
Keyword(s):  
Surgical Technique ◽  
Peripheral Nerve ◽  
Spinal Surgery ◽  
Delayed Diagnosis ◽  
Clinical Event ◽  
Litigation Risk ◽  
Success Rates ◽  
Common Cause ◽  
Delayed Treatment ◽  
Lack Of Information

Introduction Neurosurgery remains among the highest malpractice risk specialties. This study aimed to identify areas in neurosurgery associated with litigation, attendant causes and costs. Methods Retrospective analysis was conducted of 42 closed litigation cases treated by neurosurgeons at one hospital between March 2004 and March 2013. Data included clinical event, timing and reason for claim, operative course and legal outcome. Results Twenty-nine claims were defended out of court and twelve were settled out of court. One case required court attendance and was defended. Of the 42 claims, 28, 13 and 1 related to spinal (0.3% of caseload), cranial (0.1% of caseload) and peripheral nerve (0.07% of caseload) surgery respectively. The most common causes of claims were faulty surgical technique (43%), delayed diagnosis/misdiagnosis (17%), lack of information (14%) and delayed treatment (12%), with a likelihood of success of 39%, 29%, 17% and 20% respectively. The highest median payouts were for claims against faulty surgical technique (£230,000) and delayed diagnosis/misdiagnosis (£212,650). The mean delay between clinical event and claim was 664 days. Conclusions Spinal surgery carries the highest litigation risk versus cranial and peripheral nerve surgery. Claims are most commonly against faulty surgical technique and delayed diagnosis/misdiagnosis, which have the highest success rates and payouts. In spinal surgery, the most common cause of claims is faulty surgical technique. In cranial surgery, the most common cause is lack of information. Claims may occur years after the clinical event, necessitating thorough contemporaneous documentation for adequate future defence. We emphasise thorough patient consultation and meticulous surgical technique to minimise litigation in neurosurgical practice.

scholarly journals Vesicouterine Fistula in Burkina Faso: Report of 36 Cases in a Multicentric Study

2021 ◽  
Vol 2 (4) ◽  
pp. 210-215
Author(s):  
Boureima Ouedraogo ◽  
Brahima Kirakoya ◽  
Moussa Kabore ◽  
Adama Millogo ◽  
Adama Ouattara ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Burkina Faso ◽  
Success Rate ◽  
Vaginal Delivery ◽  
Medical Records ◽  
Vesicovaginal Fistula ◽  
Obstetric Fistula ◽  
Emergency Caesarean Section ◽  
Obstructed Labor ◽  
Multicentric Study

Objective: To report etiological and therapeutic features of vesicouterine fistulas (VUF) in Burkina Faso. Patients and Methods: We performed a retrospective, descriptive, and multicentric study based on the medical records of women treated for VUF from January 2010 to December 2016. Results: VUF accounted for 7.2% (36/497) of urogenital fistulas managed during the study period. The median age of the 36 patients was 35 years (interquartile range = 27 to 37.5 years) with values ranging from 16 years to 64 years old. Among VUF, obstetric fistula accounted for 26 cases (26/36) versus 10 cases (10/36) of iatrogenic fistula. Obstetric VUF were consecutive to emergency Caesarean section (n = 16) and vaginal delivery (n = 10) after prolonged obstructed labor. The 10 cases of iatrogenic VUF were subsequent to prelabour Caesarean section. The main circumstance of VUF occurrence was Caesarean section (26/36). In 10 cases (10/36), VUF was associated with a vesicovaginal fistula. Thirty days after the removal of the catheter, the success rate fell from 89% to 80.6%. Conclusion: VUF is rare but its frequency is not negligible in our context. The main circumstance of occurrence remains Caesarean section. The best treatment remains prevention.

scholarly journals Bladder stone: a rare cause of obstructed labour

2017 ◽  
Vol 4 (7) ◽  
pp. 2352
Author(s):  
Mangala Sonak ◽  
Sangeeta Ramteke ◽  
Medha Davile
Keyword(s):  
Caesarean Section ◽  
Postoperative Period ◽  
Vesicovaginal Fistula ◽  
Bladder Stone ◽  
Common Phenomenon ◽  
Fetal Head ◽  
Vesical Calculus ◽  
Obstructed Labour ◽  
Study Report ◽  
Prompt Diagnosis

Bladder stone is a rare cause of obstructed labour. Study report a case of bladder stone obstructing the labour in a multipara. Diagnosis was made during labour on pervaginal examination. The stone was impacted below the fetal head thus obstructing labour. A bladder stone weighing approximately 120 g and measuring 6x6 cm was removed by cystolithotomy at the time of caesarean section. The postoperative period was uneventful. Mechanical cause resulting in obstructed labour is a very common phenomenon but vesical calculus causing dystocia is very rare and till date very few cases of vesical calculus resulting in obstructed labour has been reported in the literature. Prompt diagnosis of the condition is very important to prevent grave complications like vesicovaginal fistula and rupture uterus.

scholarly journals Outcome and predictors of surgical repair of obstetric vesicovaginal fistula in a teaching hospital in ethiopia: retrospective cohort study

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Demisew Amenu ◽  
Ahadu Workineh ◽  
Desta Hika
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Vesicovaginal Fistula ◽  
Surgical Repair ◽  
Obstetric Fistula ◽  
Success Rates ◽  
Fistula Repair ◽  
Obstructed Labor ◽  
Cohort Study Design

Aims: To determine outcomes of obstetric fistula repair and predictors of outcomes among patients with obstetric vesicovaginal fistula. Methods: A Hospital based Retrospective Cohort study design was conducted on all patients with Obstetric vesicovaginal Fistula, who were admitted to Gynecology ward, and had surgical repair from January 2011 to December 2014. Data was collected from patients’ chart, operation logbook and discharge logbook which were filled up from the entry of the patient to the hospital till her discharge. At discharge, a dye test was done to determine the outcome of repair. Results: 168 patients with obstetric vesicovaginal fistula were repaired during the study period. The age of the women ranged from 12 to 45 years with mean of 25 (± 6) years. Eighty percent of patients were laboring for two or more days, 46.4% delivered abdominally, and 85.7% ended up in stillbirth. Out of 93.4% patients who had successful closure of their fistula, 84.5% of patients had their fistula healed and continent, 8.9 % of them developed urinary incontinence while 6.5% of fistula repair had failed at the time of discharge. Unsuccessful fistula repair was significantly associated with being divorced/widowed (AOR 2.65 95%CI 1.06,6.67), Moderate/severe vaginal scaring (AOR5.25 95% CI 2.19, 12.60). Conclusions: In this study most fistula patients are older than 18 years, referred from health centers either for cephalopelvic disproportion or obstructed labor after prolonged labor at home, high success rates were achieved with surgical repair, and being divorced /widowed and marked vaginal scarring are predictors for unsuccessful fistula repair. Therefore, increasing access to comprehensive emergency obstetric and new born care is essential to minimize the delay contributing to perinatal mortality and obstetric fistula.

scholarly journals Clinical Profile of Urogenital Fistula in Kathmandu Model Hospital

2020 ◽  
Vol 18 (2) ◽  
pp. 210-213
Author(s):  
Hema Kumari Pradhan ◽  
Ganesh Dangal ◽  
Aruna Karki ◽  
Ranjana Shrestha ◽  
Kabin Bhattachan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Outcome ◽  
Vesicovaginal Fistula ◽  
Obstetric Fistula ◽  
Abdominal Hysterectomy ◽  
Clinical Profile ◽  
Pelvic Surgery ◽  
Obstructed Labour ◽  
Genitourinary Fistula ◽  
Urogenital Fistula

Background: To determine the causes of fistula and to share our experience in treating urogenital fistula and its surgical outcome.Methods: This was a retrospective study done at Kathmandu Model Hospital from January 2014 to June 2019 including 261 patients operated for fistula. The patients were analyzed for age, type of fistula, cause, treatment and surgical outcome.Results: Out of 261 patients operated, 59.38% cases had obstetric fistula, 38.69% had iatrogenic and 1.92% had traumatic fistula. Most of the patients with obstetric fistula were between 21 to 25 years of age whereas iatrogenic fistulae were between 46-50 years of age. The majority (54.84%) of obstetric fistulae were vesicovaginal fistula (54.84%) while the commonest type (77.36%) of iatrogenic fistula was vault fistula after abdominal hysterectomy. Conclusions: This study showed that obstructed and neglected labor was still the major cause of genitourinary fistula in Nepal nevertheless iatrogenic fistula following pelvic surgery is increasing. The surgical outcome of repair of fistula was good.Keywords: Latrogenic fistula, obstructed labour, urogenital fistula.

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