ASSESSMENT OF TYPE AND CLINICAL FEATURES IN FEMALES WITH OBSTETRIC FISTULA – A CLINICAL STUDY

Obstetric fistula is an injury that occurs during prolonged and obstructed labor causing tissue damage to organs inside the pelvis and resulting in urine and fecal incontinence or both. The present study was conducted to record type and clinical features in females with Obstetric fistula. 60 patients with Female genital fistula were involved. A thorough clinical examination along with types and clinical features were recorded. Age group 10-20 years had 14 patients, 20-30 years had 26, 30-40 years had 12 and >40 years had 8 patients. The difference was significant (P< 0.05). Type of fistula was VVF in 48, RVF in 7 and RVVF in 5 cases. Clinical features comprised of urine incontinence in 38, fecal incontinence in 20 and both urine and fecal incontinence in 2 cases. The difference was significant (P< 0.05). Most common cause was VVF and RVVF. Clinical features comprised of urine and fecal incontinence

Genital fistula: Successes, challenges, and way forward in a facility specialization in fistula management in Bangladesh

Aims: To explore the prevalence, types of genital fistulas as well as their success, challenges, and way forward on genital fistula in Bangladesh. Methods: Between October 2017 and September 2018, Hope Hospital identified a total number of 101 genital fistula cases though a community network system in Cox’s Bazar. For each of the patients, detailed case histories and clinical management reports documented, and the data were interpreted using descriptive analysis. Results: Out of 101 genital fistula cases admitted to the facility, 95.3% (n=96) of cases were obstetric; three cases iatrogenic, and one each traumatic and congenital. The median age of the women was 28 years (range: 18 -73) and the median duration of two years (range: 1 month-53 years). Most of the cases had urinary incontinence (86.1 %, n=85) and 12 and two cases were fecal and mixed type respectively. Vesicovaginal fistula (VVF) repair was performed in most of the cases (78.2%, n=79) while 21.8% (n=22) received recto vaginal fistula (RVF) repair. 90% (n=91) were discharged without complication. The median duration of hospital stay was 16 days (range: 4 -29). The success rate was 86.1% (n=85), and 16 cases advised for repeat surgery. Pre-and post-surgery counselling was provided without rehabilitation or reintegration support. Conclusions: Facility data in a particular geographic location represents high prevalence of obstetric fistula and lacks rehabilitation and social reintegration support. Further study is essential to draw a complete geographical map for genital fistula in Bangladesh. Keywords: genital fistula, management, rehabilitation, Bangladesh

Repair of Vesicovaginal Fistula: Experience of 30 Cases and Analysis of Outcome Predictors

Female genital fistula is a serious medical condition in which a perforation develops most commonly between bladder and vagina (VVF). Although the majority of genitourinary fistulas can be closed surgically, the successful closure depends on many factors. In this retrospective study, the records of 30 women with a mean age of 23.8 years were assessed; 13% of the VVF occurred after abdominal hysterectomy, 67% after Caesarean section, and 20% after difficult vaginal delivery. Six (20%) women had previous repair. The median duration of the VVF was 5.9 months. Of the 30 patients of VVF, 24 were high and 6 were low. Twenty seven had single fistula opening and 3 had two fistulous openings. An abdominal approach was used in 24 patients and vaginal approach in 6 patients. At a mean follow up of 24 months, the VVF was cured in 90% patients. In conclusion, surgical correction of the VVF is more successful when done earlier, probably in the first 6 months. Abdominal approach seems to be more successful technique and recurrent VVF being associated with lower success rates than primary repair. High variety also has good result. Faridpur Med. Coll. J. Jul 2018;13(2): 85-88

Rehabilitation and reintegration programming adjunct to female genital fistula surgery: a scoping review protocol

IntroductionFemale genital fistula is a debilitating traumatic injury, largely birth-associated, globally affecting up to 2 million women, mostly in sub-Saharan Africa. Fistula has significant physical, psychological and economic consequences. Women often face challenges in reintegrating and resuming prior roles despite successful surgery. Synthesising the evidence on services adjunct to fistula surgery and their outcomes is important for developing the evidence base for best practices and identifying research priorities. This scoping review seeks to examine the range of rehabilitation and reintegration services provided as adjunct to genital fistula surgery, map the existing programming and outcomes, and identify areas for additional research.Methods and analysisOur scoping review is informed by existing methodological frameworks and will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR guidelines. The search strategy will be applied to nine biomedical, public health and social science databases. The initial search was completed on 27 September 2018. Grey literature will be identified through targeted Google searches and from organisational websites identified as relevant by the United Nations Population Fund (UNFPA) Campaign to End Fistula. We will iteratively build our search strategy through term harvesting and review, and search reference lists of reports and articles to identify additional studies. Two reviewers will independently screen titles and abstracts, followed by full-text screening of all potentially relevant articles and standardised data extraction. Articles eligible for inclusion will discuss research or programmatic efforts around service provision in adjunct to surgery among females with genital fistula. Data will be presented in summary tables accompanied by narrative description.Ethics and disseminationEthics approval is not required for a scoping review. Our results can be used to inform policy, serve as support for funding and development of reintegration programmes and highlight areas for subsequent research. Results will be disseminated at relevant conferences and published in a peer-reviewed journal.