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Debele T, Aldersey HM, Macdonald D, Mengistu Z, Mekonnen DG, Batorowicz B. Supporting Women after Obstetric Fistula Surgery to Enhance Their Social Participation and Inclusion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1201. [PMID: 39338084 PMCID: PMC11431797 DOI: 10.3390/ijerph21091201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024]
Abstract
Obstetric fistula is a childbirth complication causing abnormal openings between the urinary, bowel, and genital tracts, leading to involuntary leakage and potential long-term disability. Even after surgical repair, women continue to face psychological and social challenges that affect their social inclusion and participation. This study explored family and service provider perspectives on current support systems and identified gaps affecting women's inclusion and participation post-fistula surgery. Building on a prior study of women who underwent obstetric fistula surgical repair, we qualitatively examined available formal and informal post-surgical supports in Ethiopia. We conducted 20 interviews with family members and service providers and analyzed them using Charmaz's grounded theory inductive analysis approach. We identified four themes that indicated the available formal support in fistula care, the impact of formal support on women's social participation and inclusion, the gaps in formal support systems, and post-surgery informal supports and their challenges. Both groups believed support needs for women after surgery remain unmet, highlighting the need to strengthen holistic support services to improve women's social inclusion and participation. This study contributes to limited research on formal and informal support for women, emphasizing the need for enhanced economic, psychological, and sexual health-related support post-obstetric fistula surgery.
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Affiliation(s)
- Tibeb Debele
- Department of Rehabilitation Science, School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON K7L 3N6, Canada
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia
| | - Heather M Aldersey
- Department of Rehabilitation Science, School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON K7L 3N6, Canada
| | | | - Zelalem Mengistu
- Department of Obstetrics and Gynecology, University of Global Health Equity, Kigali 6955, Rwanda
| | - Dawit Gebeyehu Mekonnen
- Department of Rehabilitation Science, School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON K7L 3N6, Canada
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia
| | - Beata Batorowicz
- Department of Rehabilitation Science, School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON K7L 3N6, Canada
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Adhikari K, Pandit M, Lamichhane S, Pandit M, Budthapa J, Thapa BD, Paudel U. Uretero-uterine fistula following Manual Vacuum Aspiration for Incomplete abortion: A rare case report. Radiol Case Rep 2024; 19:3912-3914. [PMID: 39050649 PMCID: PMC11266978 DOI: 10.1016/j.radcr.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024] Open
Abstract
Genitourinary fistulas are a well-recognized complication of various gynecological, obstetrical, and endourological interventions. The incidence of uretero-uterine fistula is very rare compared to other genitourinary fistulas. Few cases are reported in literature regarding the uretero- uterine fistula following manual vacuum aspiration of retained product of placenta. We report a case of 28 year multi-parous women who had presented with complain of involuntary passage of urine following manual vacuum aspiration for retained product of conception. Common tests for suspicion of uretero-uterine fistula include cystoscopy, triple swab test, and CT urography. Our patient was diagnosed in CT urography and was managed by exploratory laparotomy with end-to-end anastomosis of the right ureter, DJ stenting, and repair of a uterine perforation. Due to relatively rare incidence of this condition, there has not been a specific guideline for management. A multimodality and multidisciplinary approach have been proposed for the management of uretero-uterine fistulas.
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Affiliation(s)
- Kapil Adhikari
- Department of Radio Diagnosis and Imaging, BPKIHS, Dharan, Nepal
| | - Mamata Pandit
- Tribhuvan University Institute of Medicine Maharajgunj Medical Campus Kathmandu, Maharajganj
| | | | | | - Jwala Budthapa
- Department of Radio Diagnosis and Imaging, BPKIHS, Dharan, Nepal
| | | | - Upesh Paudel
- Department of Radio Diagnosis and Imaging, Shree Birendra Hospital, NAIHS, Kathmandu, Nepal
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Zeleke LB, Welsh A, Abeje G, Khajehei M. Treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024. [PMID: 38881203 DOI: 10.1002/ijgo.15724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Obstetrical fistula is an abnormal opening between the reproductive tract and lower urinary and/or gastrointestinal tract resulting from obstetrical complications, affecting nearly two million women worldwide. It imposes physical, economic, social, and mental consequences on the affected women. Treatment outcomes vary and, mostly, surgical treatment results in improved quality of life and successful subsequent pregnancy for survivors. OBJECTIVES The review aimed to chart and examine the treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries. SEARCH STRATEGY This is a scoping review study to identify treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries. The search was conducted from databases (PUBMED, Embase, CINAHL, Scopus, and Web of Science), and gray literature (Google Scholar, Google, and conference proceedings). SELECTION CRITERIA The eligibility criteria were constructed using a participant, concept, and context framework and included study types of primary research, reviews, and reports. Studies without full text and in languages other than English were excluded. DATA COLLECTION AND ANALYSIS The relevant characteristics of the included studies were extracted on an Excel spreadsheet and analyzed to chart treatment outcomes. MAIN FINDINGS The review examined the full text of 57 studies on the treatment outcomes of obstetrical fistula. The findings were grouped into two themes: early and late outcomes. The early outcomes included incontinence, surgical-site infection, urine retention, hemorrhage, and retained catheter. The late outcomes included fistula recurrence, residual incontinence, quality of life, reproductive issues, mental health, family and social support, and financial status. CONCLUSION The treatment outcomes of obstetrical fistula can be grouped into short-term and long-term outcomes. Although this review found adequate studies for the analysis, most study designs were poor. Stronger studies are recommended in the future to guide policy and decision-making. We would like to suggest that researchers conduct systematic reviews and meta-analyses independently for short-term and long-term outcomes.
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Affiliation(s)
- Liknaw Bewket Zeleke
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alec Welsh
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gedefaw Abeje
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marjan Khajehei
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Western Sydney University, Sydney, Australia
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4
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Johnson EE, O’Connor N, Hilton P, Pearson F, Goh J, Vale L. Interventions for treating obstetric fistula: An evidence gap map. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001481. [PMID: 36963005 PMCID: PMC10021774 DOI: 10.1371/journal.pgph.0001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023]
Abstract
Obstetric fistula is prevalent in low- and middle-income countries, with between 50,000 and 100,000 new cases each year. The World Health Organization aims to eradicate it by 2030 but a clear idea of the extant evidence is unavailable. This evidence map compiled evidence on treatments for obstetric fistula to identify potential knowledge gaps. The protocol for this work was published on the Open Science Framework (DOI: 10.17605/OSF.IO/H7J35). A survey was developed, piloted and distributed online through organisations with an interest in obstetric fistula and snowballing. Results informed the evidence map framework. Searches were run on MEDLINE, Embase, CENTRAL, Global Index Medicus and ScanMedicine on 16 February 2022 to identify potentially eligible systematic reviews, randomised controlled trials, cohort studies and case-control studies. Forward and backward citation chaining was undertaken on relevant systematic reviews and included studies. Studies were screened, coded and assessed for risk of bias by a single reviewer, with a second checking a proportion. The evidence map results were compared to survey results. Thirty-nine people responded to the survey, half of which were clinicians. Of 9796 records identified, 37 reports of 28 studies were included in the evidence map. Many included studies were at some risk of bias; for observational studies, this was predominantly due to lack of controlling for confounders. Most studies (71%) assessed surgical interventions alone. Reporting on other intervention types was limited. Regarding outcome measures most important to survey respondents, 24 studies reported on cure/improvement in obstetric fistula and 20 on cure/improvement in urinary incontinence. Reporting on quality of life, faecal incontinence and sexual function was limited. There is currently little robust evidence to guide patients and practitioners on the most effective treatment option for obstetric fistula. Further research is required to address evidence gaps identified.
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Affiliation(s)
- Eugenie Evelynne Johnson
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicole O’Connor
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Hilton
- Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona Pearson
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Innovation Observatory, The Catalyst, Newcastle upon Tyne, United Kingdom
| | - Judith Goh
- Griffith University School of Medicine, Queensland, Australia
| | - Luke Vale
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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5
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Doumouchtsis SK, de Tayrac R, Lee J, Daly O, Melendez-Munoz J, Lindo FM, Cross A, White A, Cichowski S, Falconi G, Haylen B. An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders. Int Urogynecol J 2023; 34:1-42. [PMID: 36443462 PMCID: PMC9834366 DOI: 10.1007/s00192-022-05397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
AIMS The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus. METHODS This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus. RESULTS A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5-10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible. CONCLUSION A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.
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Affiliation(s)
- Stergios K. Doumouchtsis
- grid.419496.7Department of Obstetrics and Gynaecology, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
- grid.264200.20000 0000 8546 682XSt. George’s University of London, London, UK
- grid.5216.00000 0001 2155 0800Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- grid.464520.10000 0004 0614 2595School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
- School of Medicine, Ross University, Miramar, FL USA
| | - Renaud de Tayrac
- grid.411165.60000 0004 0593 8241Nimes University Hospital, Nimes, France
| | - Joseph Lee
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
| | - Oliver Daly
- grid.417072.70000 0004 0645 2884Western Health, Melbourne, Australia
| | - Joan Melendez-Munoz
- grid.411295.a0000 0001 1837 4818Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Fiona M. Lindo
- grid.63368.380000 0004 0445 0041Houston Methodist Hospital, Texas A&M University College of Medicine, Houston Methodist Hospital, Houston, TX USA
| | - Angela Cross
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Auckland, New Zealand
| | - Amanda White
- grid.89336.370000 0004 1936 9924University of Texas at Austin, Austin, TX USA
| | - Sara Cichowski
- grid.5288.70000 0000 9758 5690Oregon Health & Sciences University, Portland, OR USA
| | - Gabriele Falconi
- grid.413009.fComplex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Bernard Haylen
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
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6
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Mama ST, Chandra Regmi M. Pelvic Floor Disorders/Obstetric Fistula. Obstet Gynecol Clin North Am 2022; 49:735-749. [DOI: 10.1016/j.ogc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Corrigendum. Neurourol Urodyn 2022; 41:1637. [PMID: 35830727 DOI: 10.1002/nau.24679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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8
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Haylen B, Oelke M. RE: Joint terminology documents: Quality and a justifiable need, not quantity. Neurourol Urodyn 2022; 41:1185-1186. [PMID: 35366383 DOI: 10.1002/nau.24916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/03/2022] [Accepted: 03/03/2022] [Indexed: 11/07/2022]
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9
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Hernández-Hernández D, Navarro-Galmés MÁ, Padilla-Fernández B, Ramos-Gutiérrez VJ, Castro-Díaz DM. Same problem, different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair-case report. Transl Androl Urol 2021; 10:3885-3890. [PMID: 34804830 PMCID: PMC8575560 DOI: 10.21037/tau-21-373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022] Open
Abstract
Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O’Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.
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Affiliation(s)
- David Hernández-Hernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | | | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain.,Departamento de Cirugía, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | | | - David Manuel Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain.,Departamento de Cirugía, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
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10
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Thayalan K, Krause H, Goh J. A retrospective case series on transvaginal repair of rectovaginal fistula performed by a urogynaecology operative team in Australia. Aust N Z J Obstet Gynaecol 2021; 62:263-267. [PMID: 34611895 DOI: 10.1111/ajo.13444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/06/2021] [Accepted: 09/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rectovaginal fistula (RVF) is an abnormal epithelialised connection between the rectum and vagina. It is a common condition in limited resource settings and is caused almost exclusively by obstetric injury. In contrast, RVF is uncommonly seen in high resource settings. AIMS This study aims to review the aetiology and effectiveness of RVF management in the high resource setting, identifying predictors for repair success and long-term outcomes. MATERIALS AND METHODS A retrospective case series study of patients who underwent transvaginal RVF repairs at two secondary healthcare facilities over a 14-year period by one operative group. RESULTS A total of 41 patients underwent 46 surgical repairs. All patients presented with flatal and/or faecal incontinence and aetiology was identifiable in 78.0% (n = 32). Obstetric cause was implicated in 26.8% (n = 11) and other causes include 26.8% (n = 11) from vaginal and abdominal surgery, 14.6% (n = 6) from perianal abscess, 7.32% (n = 3) as complications of Crohn's disease and 2.44% (n = 1) as a complication of a cube pessary. Fistula was cured in 38 of 41 cases (92.7%) with a primary repair closure rate of 80.5% (n = 33). Post-operative symptoms were limited to flatal incontinence in 4.88% (n = 2), faecal incontinence in 2.44% (n = 1), and persistent perineal pain in 7.32% (n = 3). The success of the surgical repair was not significantly impacted by fistula size, aetiology, presence of a stoma for diversion, history of prior repair, duration since RVF formation or repair technique. CONCLUSIONS This review identifies aetiology for RVF in the high resource setting and highlights the role of earlier surgical repair to minimise patient morbidity with good success in closure and reduction of post-operative symptoms.
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Affiliation(s)
- Krishanthy Thayalan
- Obstetrics and Gynaecology Trainee, Mater Mothers' Hospital, South Brisbane, QLD, Australia
| | - Hannah Krause
- Greenslopes Private Hospital, Brisbane, QLD, Australia.,Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Judith Goh
- Greenslopes Private Hospital, Brisbane, QLD, Australia.,Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia.,Griffith University, Gold Coast, QLD, Australia
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11
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Potluri TK, Holt LM, Tanner JP, Wasingya L, Duffy S, Greene KA. Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study. BJOG 2021; 129:120-126. [PMID: 34258859 DOI: 10.1111/1471-0528.16845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistula repairs in Uganda. DESIGN A retrospective cohort study. SETTING A community hospital in Masaka, Uganda. POPULATION Women who underwent fistula repair at the Kitovu Hospital between 2013 and 2019. METHODS Retrospective review of demographics and clinical perioperative characteristics of patients surgically treated for urogenital fistula. Patient characteristics were compared between those who did and those who did not require a blood transfusion. MAIN OUTCOME MEASURES Need for perioperative blood transfusion and risk factors. RESULTS A total of 546 patients treated for urogenital fistulas were included in this study. The median age was 31.1 ± 13.2 years. A vaginal surgical approach was used in the majority of patients (84.6%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. In multivariable analyses, for each gram per deciliter (g/dl) increase in preoperative haemoglobin, the odds of blood transfusion decreased by approximately 28% (adjusted OR 0.72, 95% CI 0.59-0.86). Women who had their fistula repaired abdominally were 3.4 times more likely to require transfusions (95% CI 1.40-8.08). CONCLUSIONS The incidence of blood transfusions among urogenital fistula repairs in our population is twice that of developed nations. An abdominal surgical approach to urogenital fistula is a significant risk factor for perioperative blood transfusions. The timing of the repair may warrant further study. TWEETABLE ABSTRACT One of the first studies to look at blood transfusion risk factors after fistula repair in a low-resource setting.
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Affiliation(s)
- T K Potluri
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - L M Holt
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - J P Tanner
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - L Wasingya
- Depratment of Medicine, Kitovu Hospital, Masaka, Uganda
| | - S Duffy
- Kitovu Hospital Fistula Unit, Masaka, Uganda.,Chelsea and Westminster Hospital, London, UK
| | - K A Greene
- Kitovu Hospital Fistula Unit, Masaka, Uganda.,University of South Florida Department of Female Pelvic Medicine and Reconstructive Surgery, Tampa, Florida, USA
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12
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Rehabilitative care practices in the management of childbirth-related pelvic fistula: A systematic review. Int Urogynecol J 2021; 32:2311-2324. [PMID: 34089341 DOI: 10.1007/s00192-021-04845-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Childbirth-related pelvic fistula (CRF) often requires surgery, yet even with successful repair, mental health conditions, musculoskeletal impairments, urinary and fecal incontinence and sexual dysfunction persist for many women. Postoperative rehabilitation, (i.e., physiotherapy, mental health counseling) may address these concerns and has been reported for this population. This review aims to summarize the literature and level of evidence of rehabilitative care practices in fistula care to inform clinical practice, research and policy recommendations. METHODS A systematic literature review was conducted using Africa-Wide Information, CINAHL, Cochrane, Embase, Global Health, PAIS Index, PubMed and SCOPUS searching keywords and MeSH terms to identify women with CRF admitted for surgery. Two researchers progressively screened titles, abstracts and full-text articles. Eligible articles were classified primary if intervention details and outcomes were reported or secondary if rehabilitation was described, but no specific outcomes reported. Relevant study details, strengths and limitations, and key findings were extracted. RESULTS Eighteen articles were included: eight primary, ten secondary. Primary articles reported on urethral plugs for postoperative urinary incontinence (UI) (2/8), menstrual cup to manage UI (1/8), physiotherapy and health education (3/8) and mental health counseling (2/8). Secondary articles describe rehabilitation components in the context of program descriptions, qualitative analyses or reviews. All evidence was low or very low quality. CONCLUSIONS Research on rehabilitative care is very limited and highlights inconsistencies in practice. This review provides support for the feasibility of rehabilitation and establishes the need for future interventional studies that involve a comparator and reliable outcome measures.
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13
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Surgical repair and follow-up of chronic 4th degree obstetric perineal tear (total perineal defect) in 2 centres in eastern Africa. Int Urogynecol J 2021; 32:2437-2442. [PMID: 34003311 PMCID: PMC8129957 DOI: 10.1007/s00192-021-04841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/03/2021] [Indexed: 11/12/2022]
Abstract
Introduction and hypothesis Fourth-degree perineal tear occurs in up to 0.2% of vaginal deliveries. In limited resource communities, women often deliver in local villages without facilities to repair obstetric anal sphincter injuries. These fourth-degree tears heal by secondary intention and result in total perineal defects. The aim of the study is to present medium-term follow-up of a large number of women following repair of chronic fourth-degree tear. Methods Repairs of chronic obstetric fourth-degree tears were undertaken during surgical camps at Kagando Hospital, Uganda and Selian Hospital, Tanzania, from December 2013 to October 2019. Women completed Cleveland Clinic Incontinence Scores (CCIS) on admission (face to face) and during the 7-year follow-up period (via telephone). Results Two hundred fourteen women had medical history and CCIS completed on admission. The mean age at presentation was 33.9 years and mean duration of the condition was 8.9 years. Over a third of women stated they suffered social abandonment because of the unrepaired fourth-degree tear. Nearly 45% of women suffered the tear during the first vaginal delivery. At 1-year follow-up, 87% of 101 women scored 0 (perfect continence) and 94% of 66 women had perfect continence at 2 years. Forty-one births occurred during the follow-up period (32 vaginal deliveries) with two recurrences of fourth-degree tear. Conclusions Follow-up in limited resource communities is challenging. Short- to medium-term results of women who had repair of total perineal defect (unrepaired fourth-degree obstetric tears) are encouraging.
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14
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Keyser L, Myer ENB, McKinney J, Maroyi R, Mukwege D, Chen CCG. Function and disability status among women with fistula using WHODAS2.0: A descriptive study from Rwanda and Democratic Republic of Congo. Int J Gynaecol Obstet 2021; 157:277-282. [PMID: 33971022 DOI: 10.1002/ijgo.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess function and disability among women in Rwanda and Democratic Republic of Congo living with fistula and identify characteristics associated with higher disability scores. METHODS Women presenting for fistula care were recruited. Eligible participants underwent a physical examination to classify fistula type and completed the WHO Disability Assessment Schedule 2.0 questionnaire to ascertain the impact of fistula on function across six domains: cognition, mobility, self-care, getting along, life activities, and participation. Disability scores were calculated (where 0 = no disability and 100 = complete disability). Participants were grouped according to no, low, or high disability status; results were examined to determine the domains most affected. RESULTS Among 69 participants, fistula type included: vesicovaginal (59.4%), ureterovaginal (14.5%), total absence of proximal urethra (11.6%), and rectovaginal (14.5%). Median disability score was 43.0/100 (interquartile range 26.0-67.0); 83% exhibited high disability status. Life activities and participation in society domains were most affected. Women with rectovaginal fistula reported the lowest scores, and those with total absence of proximal urethra reported the highest scores. CONCLUSION WHO Disability Assessment Schedule 2.0 represents a simple, robust measure of global disability status, aligns with research efforts to estimate maternal disability, and may inform health needs and resource allocation for this population. In this study, disability was common, varied by fistula type, and affected physical, mental, and social domains.
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Affiliation(s)
- Laura Keyser
- Andrews University, Berrien Springs, MI, USA.,Mama LLC, Boston, MA, USA
| | | | - Jessica McKinney
- Andrews University, Berrien Springs, MI, USA.,Mama LLC, Boston, MA, USA
| | - Raha Maroyi
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique, Bukavu, Democratic Republic of Congo
| | - Denis Mukwege
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique, Bukavu, Democratic Republic of Congo
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15
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Cerdán-Santacruz C, Cano-Valderrama Ó, Cerdán-Miguel J. Traumatic deficient perineum: surgical management and outcome from a single center. Int Urogynecol J 2021; 33:651-658. [PMID: 33914119 DOI: 10.1007/s00192-021-04803-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Deficient perineum is a disruption of the perineal body and distal rectovaginal septum presenting with anal incontinence and a range of urogenital symptoms. There is scarce reported outcome of this condition with management often delayed and with a variety of surgical alternatives. This study aims to determine faecal continence outcomes after long-term surgical repair. METHODS Patients were included for analysis after surgical repair between 1989 and 2012. Cases were preoperatively assessed by endosonography and anorectal manometry with a record of their continence with the Cleveland Clinic Incontinence Score (CCIS). Surgical repair comprised an overlapping repair of the external anal sphincter (EAS) with levatorplasty. There was selective use of internal anal sphincter (IAS) suture and/or advancement perineoplasty for soft tissue reconstruction. Patients were clinically evaluated for functional outcomes with comparison of their postoperative CCIS. RESULTS There were 20 patients (median age 55.5 years; range 29-81 years) with a median duration of incontinence symptoms of 174 (range 1-540) months. All patients had an EAS and IAS defect with 14 (70%) undergoing an IAS suture and 10 (50%) a Corman-style anoplasty. Over a median follow-up of 137.2 (range 13-322) months, there was a significant decrease in the recorded median preoperative vs. postoperative CCIS 18, range 13-20 vs. 2, range 0-10, respectively; p < 0.001) with 18 (90%) satisfied with the functional outcome. Faecal diversion was not used in any of the patients. CONCLUSIONS Experienced delayed repair of a traumatic cloaca is associated with an acceptable functional outcome at medium- to long-term follow-up.
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Affiliation(s)
- Carlos Cerdán-Santacruz
- Colorectal Surgery Department at Clínica Santa Elena, Madrid, Spain.
- Colorectal Surgery Department at Hospital Universitario de la Princesa, Madrid, Spain.
| | - Óscar Cano-Valderrama
- General Surgery Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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16
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Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study. Adv Urol 2021; 2021:8838146. [PMID: 33531896 PMCID: PMC7840248 DOI: 10.1155/2021/8838146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years' period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. Results 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05–3.1]), low level of education (OR = 5.4; CI = [2.3–12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7–6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1–4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1–20.5]). Conclusion OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.
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