Experience of Female Urogenital Fistula – a Shift of Dominance From Obstetric Variety to Iatrogenic One

Aim: This retrospective study was carried out in Jessore Medical College Hospital and Jhenidah District Hospital on different types of female urogenital fistulae to evaluate its aetiological aspect in the present health care scenario of the country. Materials and Methods: Female patients presenting with features of urogenital fistula were evaluated properly and operated through intra-abdominal and vaginal route depending upon the merit of the fistula. Aetiological pattern of the cases was evaluated along with surgical outcome and post-operative complications. Result: Ofthe 28 female urogenital fistulas, 27 (96.43%) were VVF and 1(3.57%) was UVF. Out of 28 cases, 71.42 %( 20patients) were post-hysterectomy complication, 21.42 %( 6 patients) cases resulted from birth trauma and 7.14 %(n=2) cases were post caesarean complication. Trans-abdominal route was used for operation in 22 (78.56%) cases while 6 (21.42%) cases were operated through trans-vaginal route. In this series of 28 cases, 89.29 %( 25 cases) patients were fully cured and10.71 %( 3cases) patients experienced recurrence. Conclusion: The aetiological pattern of the female urogenital fistula in our country has changed substantially from the dominance of birth trauma to post hysterectomy indicating a remarkable improvement in maternal care system along with development of other socioeconomic parameters. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.71-75

A forgotten group during humanitarian crises: a systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings

Background Young people including adolescents face barriers to healthcare and increased risk of poor sexual and reproductive health (SRH), which are exacerbated in humanitarian settings. Our systematic review assessed the evidence on SRH interventions for young people including adolescents in humanitarian settings, strategies to increase their utilisation and their effects on health outcomes. Methods We searched peer-reviewed and grey literature published between 1980 and 2018 using search terms for adolescents, young people, humanitarian crises in low- and middle- income countries and SRH in four databases and relevant websites. We analysed literature matching pre-defined inclusion criteria using narrative synthesis methodology, and appraised for study quality. Findings We found nine peer-reviewed and five grey literature articles, the majority published post-2012 and mostly high- or medium-quality, focusing on prevention of unintended pregnancies, HIV/STIs, maternal and newborn health, and prevention of sexual and gender-based violence. We found no studies on prevention of mother-to-child transmission (PMTCT), safe abortion, post-abortion care, urogenital fistulae or female genital mutilation (FGM). Thirteen studies reported positive effects on outcomes (majority were positive changes in knowledge and attitudes), seven studies reported no effects in some SRH outcomes measured, and one study reported a decrease in number of new and repeat FP clients. Strategies to increase intervention utilisation by young people include adolescent-friendly spaces, peer workers, school-based activities, and involving young people. Discussion Young people, including adolescents, continue to be a neglected group in humanitarian settings. While we found evidence that some SRH interventions for young people are being implemented, there are insufficient details of specific intervention components and outcome measurements to adequately map these interventions. Efforts to address this key population’s SRH needs and evaluate effective implementation modalities require urgent attention. Specifically, greater quantity and quality of evidence on programmatic implementation of these interventions are needed, especially for comprehensive abortion care, PMTCT, urogenital fistulae, FGM, and for LGBTQI populations and persons with disabilities. If embedded within a broader SRH programme, implementers and/or researchers should include young people-specific strategies, targeted at both girls/women and boys/men where appropriate, and collect age- and sex-disaggregated data to help ascertain if this population’s diverse needs are being addressed.

The medical and psychological morbidity of patients with urogenital fistulae

Aims: To analyze the frequency of medical and psychological morbidity of patients with urogenital fistulae. There are many complications related to childbirth and gynaecological surgeries. Urogenital fistula is one of the worst complications. The women suffer from significant medical and psychological morbidity. These issues need to be addressed at every forum. Methods: A descriptive study was carried out at Liaquat University Hospital and Isra University Hospital Hyderabad Pakistan from 01/06/2007 to 30/06/2018. 520 patients with urogenital fistulae were managed. A pre-designed performa was used to record the details about medical and psycho-social consequences. Data was analyzed, results were described as frequency and percentage. Results: During the study period 520 confirmed cases of urinary fistulae were managed. Regarding psychological health all (100%) patients had major degree depression. 511 (98%) patients were found socially isolated. 458 (88%) patients were malnourished. 338 (65%) had severe excoriation of vulva, bladder and vaginal calculi were present 25 (4.8%) patients. Majority of the patients were suffered social, verbal and physical abuse. Conclusions: Patients with urogenital fistulae are not only having the surgical morbidity but they do suffer significant medical and social morbidity. There is a definite need to address these under looked miseries by a devoted fistulae team work in collaboration with social workers, religious leaders and healthcare providers to bring life back to these patients.

Management Of Vesicouterine Fistulae During "Fistulae Surgical Caravan" in Cote D'ivoire

Aims: Describe the epidemiological, clinical and therapeutic characteristics of patients treated for vesico-uterine fistula. Methods: This was a case series of 34 patients prospectively collected for descriptive purposes. Theywere treated for Vesico-uterine fistulae during "fistulas surgical caravans" from 1stJanuary 2012 to 31st December 2016. Results: Vesico-uterine fistulae represented 2.1% of all treated urogenital fistulae. At the time of fistula occurrence, the average age of the patients was 33.3 years, and the majority were illiterate (88.2%), lived in rural areas and were unemployed (73.5%). All the fistulae were associated to childbirth, the majority of which took place on a scarred uterus (67.6%). And this childbirth responsible for the fistula was a delivery done by caesarean section in 97.7% of cases. Average duration of the fistula before management was 6 years. Finally, all the patients were operated by the same surgical technique, made by abdominal extra peritoneal transvesical way. The successful first repair rate was 97.1% in 33 patients. The only case of failure was successfully cured using surgical another technique in a second attempt. Conclusion: The vesicouterine fistulae were rare, were mostly associated to previous uterus surgical history and the successful rate is almost 100%.

Management of Vesicouterine Fistulae during "Fistulae Surgical Caravan" in Cote D'ivoire

Aims : To describe the epidemiological, clinical and therapeutic characteristics of patients treated for vesico-uterine fistula. Methods : This was a case series of 34 patients prospectively collected for descriptive purposes. They were treated for Vesico-uterine fistulae during "fistulas surgical caravans" from 1st January 2012 to 31st December 2016. Results :Vesico-uterine fistulae represented 2.1% of all treated urogenital fistulae. At the time of fistula occurrence, the average age of the patients was 33.3 years, and the majority were illiterate (88.2%), lived in rural areas and were unemployed (73.5%). All the fistulae were associated to childbirth, the majority of which took place on a scarred uterus (67.6%). And this childbirth responsible for the fistula was a delivery done by caesarean section in 97.7% of cases. Average duration of the fistula before management was 6 years. Finally, all the patients were operated by the same surgical technique, made by abdominal extra peritoneal transvesical way. The successful first repair rate was 97.1% in 33 patients. The only case of failure was successfully cured using surgical another technique in a second attempt. Conclusion: The vesicouterine fistulae were rare, were mostly associated to previous uterus surgical history and the successful rate is almost 100%.

Management of Vesicouterine fistulae during fistulae surgical caravan in Cote d'Ivoire

Background: The urogenital fistula (UGF) which designate a solution of continuity between the urinary and genital tracts in women, are divided into several entities of variable gravity. The objective of this study was to describe the epidemiological, clinical and therapeutic characteristics of patients treated for vesicouterine fistula during ‘fistulas surgical caravans’.Methods: This was a prospective and descriptive study on a cohort of 34 patients treated for Vesico-uterine fistulae during ‘‘fistulas surgical caravans '' from 1st January 2012 to 31st December 2016.Results: Vesico uterine fistulae represented 2.1% of all urogenital fistulae treated. At the time of occurrence of fistulas, the average age of the patients stay was 33.3 years, and the majority was not educated (88.2%), lived in rural areas without occupations (73.5%). All the fistulae were secondary to childbirth, the majority of which took place on a scarred uterus (67.6%). And this childbirth responsible for the fistula was done by caesarean section in 97.7% of cases. Then the average duration of the fistula before management was 6 years. Finally, all the patients were operated by the same surgical technique, made by abdominal extra peritoneal transvesical way. The cure rate after this surgical technique was 97.1% (33 patients). The only case of failure required a second operation by another technique which permitted the healing of the patient.Conclusions: The vesicouterine fistulae were rare and the satisfactory results of their management invite us to sustain these surgical caravans and ensure their widespread.