Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital

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.

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Profile of Obstetric and Iatrogenic Fistula Surgeries At Kathmandu Model Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i2.21851 ◽

2018 ◽

Vol 13 (2) ◽

Author(s):

R Shrestha ◽

A Karki ◽

G Dangal ◽

H Pradhan ◽

K Bhattachan ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Outcome ◽

Primary Outcome ◽

Obstetric Fistula ◽

Urinary Continence ◽

Gynecological Surgery ◽

Hospital Records ◽

Fistula Surgery ◽

Urogenital Fistula ◽

Prolonged Labor

Aims: To find out the pattern of urogenital fistula. 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 data were collected from the hospital records. The fistulae were classified according Goh system. Patients’ demography, obstetric characteristics and surgical outcome were reviewed. The primary outcome was in terms of urinary continence. Results: Among 222 cases, majority of the patients had fistula due to obstetrical cause, contributing 58% (n=127) and 42% (n=95) had fistula after gyanaecological surgery. The age ranged from 15 to 65 years. 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. Hundred (78.7%) cases of obstetric fistula patients were dry and continent after surgery, whereas 95(89.4%) cases of fistula after gynecological surgery were successfully repaired. Eighteen patients with obstetric fistula and 6 patients with fistula after gynecological surgery had failed repair. Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric fistula, but fistula resulting after gynecological surgery should not be overlooked. Keywords: fistula, iatrogenic, labour

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Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study

African Journal of Urology ◽

10.1186/s12301-021-00147-9 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Olatunji O. Lawal ◽

Rukiyat Adeola Abdus-salam ◽

Oluwasomidoyin O. Bello ◽

Imran O. Morhason-Bello ◽

Oladosu A. Ojengbede

Keyword(s):

Stress Incontinence ◽

Obstetric Fistula ◽

Cross Sectional Study ◽

Successful Outcome ◽

Urinary Continence ◽

Urethral Reconstruction ◽

Vaginal Fistula ◽

Sectional Study ◽

Cross Sectional ◽

Vesico Vaginal Fistula

Abstract Background Obstetric fistula (OF) complicated by urethral loss (UL) poses a challenge to both the fistula surgeon and obstetric fistula patient. The involvement of the urethra and urethral closure mechanism in OF is an important determinant of successful closure of fistula and restoration of urinary continence. OF with UL is often associated with unsuccessful repair outcome. We describe urethral reconstruction in genital tract fistula patients with UL and the outcomes of the repair. Methods Aim To review the clinical characteristics and outcome of vesico-vaginal fistula associated urethral loss following urethral reconstruction. This was a descriptive cross-sectional study conducted at the University College Hospital, Ibadan, Nigeria. A 5-year prospective data of all vesico-vaginal fistula patients with urethral loss (2011–2016) were reviewed and analysed. Data collected include socio-demographic and obstetric characteristics; cause of the fistula; and fistula characteristics—type of fistula, number of previous repairs, urethral loss, outcome of repair and follow-up. Data were entered and analysed using IBM SPSS version 20. Results Urethral loss occurred in 23 (15.3%) out of 150 women with OF; these women had urethral reconstruction surgery. The commonest type of urethral loss encountered in this cohort was proximal urethral loss which was seen in 12 (52.2%) patients. The most common types of fistula seen with urethral loss were large vesico-vaginal fistula (34.8%) and mid-vaginal fistula (26.1%). More than half of the women (56.6%) had previous unsuccessful repair at other facilities before presentation. The fistula closure rate was high (82.6%) regardless of type of urethral loss. Among the women with successful closure of OF with UL, about 36.8% had urinary stress incontinence post-fistula repair. Conclusion Urethral loss appears to be a rare complication of obstetric fistula. Successful closure with stress incontinence was seen in a sizeable number of women with OF with UL. Preoperative assessment for determinant of post-repair incontinence and surgical repair by experienced surgeons will improve successful outcome of repair in women with obstetric fistula with UL.

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Experience of Managing Urogenital Fistula

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v9i1.11181 ◽

2014 ◽

Vol 9 (1) ◽

pp. 17-20

Author(s):

HK Pradhan ◽

G Dhangal ◽

A Karki ◽

R Shrestha ◽

K Bhattachan

Keyword(s):

Primary Outcome ◽

Community Hospital ◽

Obstetric Fistula ◽

Regional Hospital ◽

Urinary Continence ◽

Fistula Surgery ◽

Obstructed Labour ◽

Urogenital Fistula ◽

Type Site ◽

Urogenital Fistulae

Aim: The study was done to review the demography of urogenital fistulae including obstetric fistula (OF) and its surgical outcome in the early phase of fistula surgery and to create awareness about OF. Methods: This was a retrospective study of 47 patients who underwent fistula surgery during the period of January 2012 to May 2014 in Kathmandu Model Hospital, Helping Hand Community Hospital, Camp in Mid-wetern Regional Hospital Surkhet and Hamlin Hospital, Ethiopia. The primary outcome was in terms of urinary continence after 14 days of repair. Results: In the study 70% (n=33) of fistula were due to obstructed labour and 30% (n=14) were due to hysterectomy for gynecological indications. Ninety six percent (n=45) had successful closure of fistula. Seventy seven percent (n=36) were continent after surgery, and 17% (n=8) had some stress incontinence. Conclusions: The study showed obstructed labour was the major cause of OF, however iatrogenic fistula was also becoming common. The success of repair depended on the type, site, size of fistula and urethral length. Majority of our cases had successful closure of fistula with some degree of stress in some patients. DOI: http://dx.doi.org/10.3126/njog.v9i1.11181 NJOG 2014 Jan-Jun; 2(1):17-20

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Surgical Outcome of Hundred Vesico Vaginal Fistula Patients in National Fistula Centre

Bangladesh Medical Journal ◽

10.3329/bmj.v48i1.50190 ◽

2019 ◽

Vol 48 (1) ◽

pp. 39-43

Author(s):

Shamima Akhter ◽

Mst Mahbuba ◽

Nusrat Ara Yusuf ◽

Munirunnessa ◽

Nasrin Rosy

Keyword(s):

Surgical Outcome ◽

Obstetric Fistula ◽

Economic Status ◽

Cross Sectional Study ◽

Easy Access ◽

Vaginal Fistula ◽

Cross Sectional ◽

Splitting Technique ◽

Operative Care ◽

Vesico Vaginal Fistula

Vesico-vaginal fistula (VVF) is still a major global health problem.This study was performed to detect the surgical outcome of 100 VVF patients in National Fistula Centre. A descriptive cross sectional study was carried out among 100 VVF patients fulfilling the inclusion criteria admitted in the National Fistula Centre under the department of Obstetrics and Gynaecology during the study period of April, 2017 to September, 2017. During the period, 100 patients presented for surgical repair at a mean age of 28.7 years (SD7.1). Majority of them (49%) had a parity of one and 57% were less than 20 years old at the time of their first pregnancy. About 83% of women developed VVF following prolonged obstructed labour. Most of the fistula (95%) repaired through vaginal route by flap splitting technique and 73% repaired at 1st time. Recovery of most of the patient (75%) was uneventful. Inadequate post-operative care (26.9%) was the major causes of unsuccessful repair. Obstetric fistula is one of the tragedies of third world countries and it would be better solved by providing surgical procedure and easy access of all women to competent obstetrical care, irrespective of their social and economic status during pregnancy and delivery. Bangladesh Med J. 2019 Jan; 48 (1): 39-43

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Transection Type, Vesico-Vaginal Fistula Surgery

Open Journal of Urology ◽

10.4236/oju.2020.1011031 ◽

2020 ◽

Vol 10 (11) ◽

pp. 263-274

Author(s):

Mamadou II. Barry ◽

Ibrahima Sory Diallo ◽

Mamadou Bissiriou Bah ◽

Demba Cisse ◽

Thierno Mamadou Oury Diallo ◽

...

Keyword(s):

Vaginal Fistula ◽

Fistula Surgery ◽

Vesico Vaginal Fistula

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Pregnancy after Obstetric Fistula: Should It Be Encouraged?

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i3.23447 ◽

2018 ◽

Vol 13 (3) ◽

pp. 56-58

Author(s):

Ranjana Shrestha ◽

Kenusha Devi Tiwari ◽

Ganesh Dangal ◽

Aruna Karki ◽

Hema Pradhan ◽

...

Keyword(s):

Obstetric Fistula ◽

Mode Of Delivery ◽

Public Health Problem ◽

Successful Outcome ◽

Elective Cesarean Section ◽

Major Public Health Problem ◽

Fistula Repair ◽

Obstructed Labor ◽

Operative Care ◽

Elective Cesarean

Obstetric fistula (OF) is a life-changing morbidity associated with childbirth. It occurs especially after a prolonged obstructed labor and is a major public health problem in the developing countries. The smell of stool and urine leads to the ostracization and rejection of fistula patients by their spouses, families, friends and society in whole. Surgical treatment of fistula is possible. However, this successful outcome of fistula repair surgery is dependent on pre-operative care and the post-operative care such as delaying the commencement of sexual intercourse and delaying conception. Family planning can aid to this. Pregnancy is advised after minimum of 12 months’ post-repair and mode of delivery should be elective cesarean section. Here, we present a case of 23 years’ female, who suffered from obstetric fistula who underwent obstetric fistula repair twice, re-married and conceived after a year with successful elective cesarean delivery.

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LAPAROSCOPIC ROBOT ASSISTED VESICO-VAGINAL FISTULA REPAIR WITH PERITONEAL FLAP INLAY

European Urology Supplements ◽

10.1016/s1569-9056(08)61047-7 ◽

2008 ◽

Vol 7 (3) ◽

pp. 337

Author(s):

N. Engel ◽

H. John

Keyword(s):

Vaginal Fistula ◽

Fistula Repair ◽

Robot Assisted ◽

Peritoneal Flap ◽

Vesico Vaginal Fistula

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

Obstetrics and Gynecology International ◽

10.1155/2018/6396387 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

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.

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