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Diaouga HS, Yacouba MC, Garba RM, Salifou I, Manzo MSO, Nayama M. Youssef's syndrome, a rare complication of caesarean section: A case report. Int J Surg Case Rep 2024; 117:109517. [PMID: 38461587 PMCID: PMC10938133 DOI: 10.1016/j.ijscr.2024.109517] [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: 02/13/2024] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Youssef's syndrome or vesico-uterine fistula is an abnormal communication between the bladder and the uterus. It complicating of dystocic delivery, caesarean section and uterine rupture. The prevalence is globally 1-4 % of all obstetric fistulas. In Niger, it accounts for 6.4 % of iatrogenic urogenital fistulas. The best treatment is transvesical or transperitoneal surgery to close the bladder and uterus separately, with or without retaining the uterus. CASE PRESENTATION We report a case of Youssef's syndrome secondary to caesarean section for uterine rupture in a 32-year-old woman. She consulted in our department for urinary incontinence occurred in the postoperative period. The diagnosis was made on clinical examination using the methylene blue test that is the only diagnosis method available in our setting. Treatment was initially medical with a bladder catheter until uterine involution (six weeks), followed by surgical cure using the Chassar-Moir technique. DISCUSSION Youssef's syndrome accounts 1-4 % in general population, 6.4 % in west Africa and 5,2 % in Niger. Various management were reported: Medical treatment, surgical treatment via transvesical, retroperitoneal and transperitoneal routes that remains the most indicated method and, cystoscopic fulguration and laparoscopic treatment that have recently been proposed. CONCLUSION This study reminds practitioners to be more vigilant in preventing this complication during any pelvic surgery by ensuring: careful release of vesico-uterine adhesions, bladder leakage test and careful repair of any bladder wounds followed by postoperative bladder drainage.
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Affiliation(s)
- Hamidou Soumana Diaouga
- Abdou Moumouni University, Department of Obstetrics and Gynecology, Maternity Issaka Gazobi in Niamey, Niger.
| | - Maimouna Chaibou Yacouba
- Abdou Moumouni University, Department of Obstetrics and Gynecology, Mother and Child Health Center of Tahoua, Niger
| | - Rahamatou Madeleine Garba
- Abdou Moumouni University, Department of Obstetrics and Gynecology, Maternity Issaka Gazobi in Niamey, Niger
| | - Issa Salifou
- Abdou Moumouni University, Department of Obstetrics and Gynecology, Mother and Child Health Center of Tahoua, Niger
| | | | - Madi Nayama
- Abdou Moumouni University, Department of Obstetrics and Gynecology, Maternity Issaka Gazobi in Niamey, Niger
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Ngongo CJ, Raassen TJIP, Mahendeka M, Lombard L, van Roosmalen J. Iatrogenic genito-urinary fistula following cesarean birth in nine sub-Saharan African countries: a retrospective review. BMC Pregnancy Childbirth 2022; 22:541. [PMID: 35790950 PMCID: PMC9254569 DOI: 10.1186/s12884-022-04774-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Genito-urinary fistulas may occur as complications of obstetric surgery. Location and circumstances can indicate iatrogenic origin as opposed to pressure necrosis following prolonged, obstructed labor. Methods This retrospective review focuses on 787 women with iatrogenic genito-urinary fistulas among 2942 women who developed fistulas after cesarean birth between 1994 and 2017. They are a subset of 5469 women who sought obstetric fistula repair between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. We compared genito-urinary fistula classifications following vaginal birth to classifications following cesarean birth. We assessed whether and how the proportion of iatrogenic genito-urinary fistula was changing over time among women with fistula, comparing women with iatrogenic fistulas to women with fistulas attributable to pressure necrosis. We used mixed effects logistic regression to model the rise in iatrogenic fistula among births resulting in fistula and specifically among cesarean births resulting in fistula. Results Over one-quarter of women with fistula following cesarean birth (26.8%, 787/2942) had an injury caused by surgery rather than pressure necrosis due to prolonged, obstructed labor. Controlling for age, parity, and previous abdominal surgery, the odds of iatrogenic origin nearly doubled over time among all births resulting in fistula (aOR 1.94; 95% CI 1.48–2.54) and rose by 37% among cesarean births resulting in fistula (aOR 1.37; 95% CI 1.02–1.83). In Kenya and Rwanda the rise of iatrogenic injury outpaced the increasing frequency of cesarean birth. Conclusions Despite the strong association between obstetric fistula and prolonged, obstructed labor, more than a quarter of women with fistula after cesarean birth had injuries due to surgical complications rather than pressure necrosis. Risks of iatrogenic fistula during cesarean birth reinforce the importance of appropriate labor management and cesarean decision-making. Rising numbers of iatrogenic fistulas signal a quality crisis in emergency obstetric care. Unaddressed, the impact of this problem will grow as cesarean births become more common. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04774-0.
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Cassell III AK, Manobah B. Management of genitourinary trauma – current evaluation from the Sub-Saharan region: A systematic review. World J Crit Care Med 2021; 10:377-389. [PMID: 34888163 PMCID: PMC8613721 DOI: 10.5492/wjccm.v10.i6.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/19/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Trauma is a major cause of morbidity globally and the sixth leading cause of death, accounting for 10% of all mortalities. The genitourinary trauma is estimated for approximately 10% of all patients presenting with trauma, and the kidney is the most injured genitourinary organ globally. However, there is a paucity of data on genitourinary injury from the Sub-Saharan, and there may be variations from common genitourinary organs injured in developed nations.
AIM To provide insight on the epidemiology and management of genitourinary trauma in Sub-Saharan Africa with recommendations based on international guidelines.
METHODS A thorough literature search of genitourinary trauma was conducted using PubMed, Google Scholar and African Journal Online.
RESULTS A total of 30 studies from the Sub-Saharan region were eligible for the study and reviewed for epidemiology, biodata, types of injury, mechanisms of injury, treatment and follow-up. After evaluating 21904 patients presenting with urological emergencies, approximately 6.6% of cases were due to genitourinary trauma. The commonest injury was urethral 42.9% (22.2-62.2%) followed by injury to the external genitalia (penis, scrotum, testes) 25.1% (8.8-67.7%).
CONCLUSION Genitourinary injury in Sub-Saharan Africa is underreported, and the presence of more trauma registries, trained urologists and trauma facilities could improve the overall standard of care as well as providing data for research and development in the field.
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Affiliation(s)
- Ayun K Cassell III
- Department of Surgery, John F. Kennedy Medical Center, Monrovia 100010, Liberia
| | - Burgess Manobah
- Department of Surgery, John F. Kennedy Medical Center, Monrovia 100010, Liberia
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Vesico-vaginal fistula in Tunisia: Epidemiology and risk factors of treatment failure. Prog Urol 2021; 31:1175-1181. [PMID: 34656449 DOI: 10.1016/j.purol.2021.09.006] [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: 04/01/2021] [Revised: 05/17/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Vesico-vaginal fistula (VVF) is a global healthcare problem that has a high prevalence in developing countries. The aim of this work is to study the epidemiological, clinical and therapeutic characteristics of VVF post-obstetric and gynecologic procedures in order to identify the predictive factors of surgical treatment failure. METHODS Data were collected from 132 VVF patients in our institution between 1985 and 2017. VVF was classified according to Zmerli's classification. Patients underwent surgical treatment and were evaluated after a follow-up period of 6 months. Successful treatment was defined as the absence of urine leakage whereas recurrence was defined as the presence of urine leakage immediately after the surgery or after a period of dryness with a confirmed VVF. Risk factors of surgical treatment failure were identified. RESULTS The average age of patients was 44 years. The patients were multiparous in 62% of cases. VVF was consecutive to hysterectomy in 62.1% of cases, and after childbirth in 34%. VVF was retro-trigonal in 99 cases (75%) and trigonal in 33 cases (25%). The average size of the fistula was 1cm (0.3-2cm). VVF repair was performed by vaginal approach in 68% of cases and abdominal approach in 32% of cases. Treatment failure was noted in 36 patients (27%). Predictive factors of treatment failure were: vaginal fibrosis (P<0.001); trigonal location of the fistula (P<0.001); large diameter of the VVF>1cm (P<0.001); and complex and complicated fistulas (P=0.02). CONCLUSION Although Tunisia is a developing country, the main cause of VVF was not obstetrical. Treatment failure, noted in almost one third of cases, was, in our series, correlated with the quality of the vaginal tissue, the size and the location of the fistula, and its complexity. LEVEL OF PROOF 4.
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Ouattara A, Pare AK, Kabore FA, Yameogo C, Ky D, Bayané D, Ye D, Kambou T. Iatrogenic Ureteral Injuries Associated with Gynecological and Surgical Procedures: Our Experience About 18 Cases and Literature Review. Res Rep Urol 2021; 13:289-293. [PMID: 34079774 PMCID: PMC8164722 DOI: 10.2147/rru.s299590] [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: 02/22/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Aim To describe the epidemiological aspects, etiology and outcome of iatrogenic ureteral injury repair at the urology division of Souro Teaching Hospital of Bobo Dioulasso (Burkina-Faso). Patients and Methods This was a retrospective descriptive study of consecutive patients with iatrogenic ureteric injuries who were referred and managed in the urology division of Souro Sanou Teaching Hospital (Bobo-Dioulasso) from January 2012 to December 2017. Variables studied were age, the time at the diagnosis, the causative event, the method of repair, and the outcome of the management. Results The mean age was 37.72±3.5 years coming from the rural population in most cases. The mean time at the diagnosis was 15 days. The injuries were due to gynecologic surgeries with hysterectomy (66%) and caesarian section (33%). Ureteric reimplantation with anti-reflux system was performed in seventeen patients. The rate of treatment success was 94% and the postoperative course was uneventful for all the patients. Conclusion Iatrogenic ureteric lesions at the department of urology of Sanou Sourou teaching hospital of Bobo Dioulasso were mainly caused by gynecologic and obstetric surgeries like hysterectomy and caesarian section.
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Affiliation(s)
- Adama Ouattara
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Abdoul-Karim Pare
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | | | - Clotaire Yameogo
- Division of Urology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Desire Ky
- Division of Urology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Dramane Bayané
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Delphine Ye
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Timothee Kambou
- Division of Urology, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
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Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, Gibbons D, Kelly NM, Kennedy HP, Kidanto H, Taylor P, Temmerman M. Short-term and long-term effects of caesarean section on the health of women and children. Lancet 2018; 392:1349-1357. [PMID: 30322585 DOI: 10.1016/s0140-6736(18)31930-5] [Citation(s) in RCA: 584] [Impact Index Per Article: 97.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 02/08/2023]
Abstract
A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose-response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.
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Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK.
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK
| | - Lisa Avery
- Department of Community Health Sciences, Centre for Global Public Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Glen Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Obstetrics and General Hospital, Port Moresby, Papua New Guinea
| | - Gerard Ha Visser
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| | - Caroline Se Homer
- Maternal and Child Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - Deena Gibbons
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London UK
| | - Niamh M Kelly
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK
| | | | | | - Paul Taylor
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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