Complex obstetric fistulas
- 31 August 2007
- journal article
- review article
- Published by Wiley in International Journal of Gynecology & Obstetrics
- Vol. 99 (S1), S51-6
- https://doi.org/10.1016/j.ijgo.2007.06.026
Abstract
Obstetric fistulas are rarely simple. Most patients in sub-Saharan Africa and parts of Asia are carriers of complex fistulas or complicated fistulas requiring expert skills for evaluation and management. A fistula is predictably complex when it is greater than 4 cm and involves the continence mechanism (the urethra is partially absent, the bladder capacity is reduced, or both); is associated with moderately severe scarring of the trigone and urethrovesical junction; and/or has multiple openings. A fistula is even more complicated when it is more than 6 cm in its largest dimension, particularly when it is associated with severe scarring and the absence of the urethra, and/or when it is combined with a recto-vaginal fistula. The present article reviews the evaluation methods and main surgical techniques used in the management of complex fistulas. The severity of the neurovascular alterations associated with these lesions, as well as inescapable limitations in staff, health facilities, and supplies, make their optimal management very challenging.Keywords
This publication has 20 references indexed in Scilit:
- Traumatic absence of the proximal urethraAmerican Journal of Obstetrics and Gynecology, 2005
- Vesico‐vaginal fistulaBJU International, 2004
- The obstetric vesicovaginal fistula: Characteristics of 899 patients from Jos, NigeriaAmerican Journal of Obstetrics and Gynecology, 2004
- Ten-Year Experience With Transvaginal Vesicovaginal Fistula Repair Using Tissue InterpositionJournal of Urology, 2003
- Role of the Martius procedure in the management of urinary–vaginal fistulasJournal of the American College of Surgeons, 2000
- Vesicovaginal fistulaBJU International, 1999
- Epidemiological and surgical aspects of urogenital fistulae: A review of 25 years' experience in southeast NigeriaInternational Urogynecology Journal, 1998
- The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992International Urogynecology Journal, 1996
- Transvaginal mobilization and utilization of the anterior bladder wall to repair vesicovaginal fistulas involving the urethraObstetrics & Gynecology, 1992