An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas

Abstract

Introduction The terminology for female pelvic floor fistulas (PFF) needs to be defined and organized in a clinically based consensus Report. Methods This Report combines the input of members of the International Continence Society (ICS) assisted at intervals by external referees. Appropriate core clinical categories and a sub‐classification were developed to give a coding to definitions. An extensive process of 19 rounds of internal and external review was involved to examine each definition, with decision‐making by collective opinion (consensus). Results A terminology report for female PFF, encompassing 416 (188 NEW) 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 interpretable by practitioners and trainees in different specialty groups involved in female pelvic floor dysfunction and PFF. Female‐specific imaging (ultrasound, radiology, and magnetic resonance imaging) and conservative and surgical PFF managements as well as appropriate figures have been included to supplement and clarify the text. Interval (5–10 years) review is anticipated to keep the document updated and as widely acceptable as possible. Conclusion A consensus‐based terminology report for female PFF has been produced to aid clinical practice and research.

Surgical repair and follow-up of chronic 4th degree obstetric perineal tear (total perineal defect) in 2 centres in eastern Africa

“…In these lowresource areas, the perineal tears are not sutured and heal by secondary intention. The fusion of the torn edges of the vagina and anorectal tissues results in a total perineal defect [7] with absent perineal body and complete separation of the anal sphincters. Apart from the effects on anal continence, unrepaired fourth-degree tears have been shown to cause social stigmatization and abandonment of these women by their husbands and families [15] and mental health dysfunction [16].…”

“…All women with an unrepaired fourth-degree obstetric perineal tear (total perineal defect) [7] (Fig. 1) were invited to participate in the study and were assessed in the outpatient clinic.…”

“…However, in many parts of the world, women deliver in local villages with no facilities for emergency obstetric services or infrastructures available to repair obstetric anal sphincter injuries. These fourth-degree tears heal by secondary intention, resulting in total perineal defects [7].…”

Function and disability status among women with fistula using WHODAS2.0: A descriptive study from Rwanda and Democratic Republic of Congo

“…Pelvic fistula is among the most severe maternal morbidities. It is an atypical connection between the upper or lower genital tract and adjacent upper or lower urinary tract and/or Accepted Article lower gastrointestinal tract [9]. It results in the uncontrolled passage of urine and/or feces and often leads to severe physical, psychological and economic consequences.…”

Same problem, different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair—case report

“…Vesicovaginal fistula (VVaF) is an abnormal connection between the vagina and the bladder that conditions a constant flow of urine into the vagina. Following the recent International Continence Society (ICS) report on the terminology for female pelvic floor fistulas, it affects both the anterior vaginal wall and the posterior bladder wall with or without involvement of the ureteric orifices (1).…”