Urinary fistula-A continuing problem with changing trends

Kumar, Sunesh; Vatsa, Richa; Bharti, Juhi; Roy, Kallol Kumar; Sharma, Jai Bhagwan; Singh, Neeta; Meena, Jyoti; Singhal, Seema

doi:10.4274/jtgga.2016.0211

Cited by 14 publications

(4 citation statements)

References 13 publications

(22 reference statements)

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“…The age of the subjects in this study ranged from 13-55 years with a mean of 28±11.1 years. This is similar to the findings of Kumar et al, Karateke et al and Amitava et al [12][13][14] This age range is within the child-bearing age of women as well as the age when obstetric and gynaecologic surgeries are most commonly performed. The youngest patient in this study was 13 years at the time of presentation.…”

Section: Discussionsupporting

confidence: 91%

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

et al. 2020

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Background: Management of complex genital fistulae is challenging due to the cost and technical skill required. This study reports our experience in the management of patients with complex genital fistulae and to highlight the crucial role of the reconstructive urologists.Methods: This was a retrospective review of female patients managed at a tertiary hospital in Nigeria from 2006 to 2017 for complex urinary fistulae. Data were extracted from patient case notes and the data analysed using the SPSS software.Results: Twenty-four female patients mean age 28.9±11.1 years. Fistulae resulted from prolonged obstructed labour 10 (41.6%), caesarean hysterectomy 7 (29.2%), caesarean section and abdominal hysterectomy 2 (8.4%) respectively. The fistulae were vesicovaginal 16 (66.7%), ureterovaginal 3 (12.5%). Others were vesicocutaneous, urethrovaginal and rectovaginal. Prior attempts at repair were done in 7 (29.2%) and the number of attempts ranged from 1 to 4. Surgical procedures included direct closure in 9 (37.5%), closure and uretero-neocystostomy 7 (29.2%), uretero-neocystostomy only 3 (12.5%) closure and abdominal hysterectomy 2 (8.3%), closure and continent catheterizable neo-bladder 2 (8.3%) and 1 (4.2%) closure, abdominal hysterectomy and uretero-neocystostomy. Post-operative complications were noted in 2 (8.3%) and consisted of gynaeatresia and recurrent RVF. Repair was successful in 70.8% of patients while failed repair was recorded in 16.7% and while stress incontinence was present in 12.5%.Conclusions: Complex genital fistulae in our practice are of obstetric origin involving the bladder, ureters and rectum. The reconstructive urologist has a crucial role the management for a favourable outcome.

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Section: Discussionsupporting

confidence: 91%

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

et al. 2020

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“…An Indian study conducted from 2007 to 2013 reported that 39% of genitourinary fistulae were iatrogenic . A further study, conducted from 2011 to 2015 in India, reported that 65% of fistula cases were iatrogenic . Similarly, urogenital fistula studies conducted in Pakistan over various years have shown a gradual rising trend in iatrogenic fistula.…”

Section: Discussionmentioning

confidence: 99%

Rising trends in iatrogenic urogenital fistula: A new challenge

Tasnim

Bangash

Amin

et al. 2020

Intl J Gynecology & Obste

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Objective: To analyze trends in iatrogenic urogenital fistula among patients admitted for fistula repair at the Pakistan Institute of Medical Sciences, Islamabad.Methods: In this longitudinal study, all patients who presented for fistula repair between 2006 and 2018 were included in the study. Patient data were collected on age, parity, and type and etiology of fistula, which was classified as ischemic or iatrogenic. Results:Of 634 fistula patients, 371 (58.5%) had iatrogenic fistula, while 263 (41.5%) patients developed ischemic fistula due to obstructed labor. Mean age of patients was 31.6 years. Yearly trends showed an increase in iatrogenic fistula from 43.2% in 2006-2008 to 71.4% in 2017-2018. The major etiological contributor to iatrogenic fistula was hysterectomy (52.5%), followed by cesarean hysterectomy (26.4%), and cesarean delivery (19.9%). Conclusion:A rising trend in iatrogenic fistula was observed. This emphasizes the need for optimization of surgical approaches and surgical skills. Moreover, gynecologic surgeries should be restricted to authorized gynecologic surgeons. K E Y W O R D S Iatrogenic fistula; Obstetric fistula; Pakistan; Trends quality of health care and training systems. Although surgical training offers a possible solution, health personnel may not have gained adequate practical experience to deal with complicated deliveriesand surgical procedures. Therefore, there is a need for advanced training for improved decision-making and surgical skills in both obstetric and gynecologic management, especially for safe cesarean delivery and hysterectomy. Furthermore, despite the declining trend in obstetric fistula, measures must also be taken to further improve health services in access-restricted areas. These measures will ultimately lead to a better healthcare system and decrease the rate of fistula development.In conclusion, the present study observed a rising trend in iatrogenic fistula over almost 12 years at a single center in Islamabad, Pakistan. These recent increasing trends in iatrogenic urogenital fistula emphasize the importance of improving safety standards for surgical techniques, both obstetric and gynecologic. AUTHOR CONTRIBUTIONSNT designed and directed the project and drafted the manuscript. KB directed the project and carried out data collection. OA performed data analysis and interpretation and drafted and critically revised the manuscript. SL and HH conducted data collection.

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“…Patients presented with symptoms for a median duration of 8 months. 13 They also classified fistula as simple and complicated based on characteristics of fistula, such as number, site, size, urethral involvement, scarring of tissue, and number of previous repairs. Simple fistulae were present in 55.0% women and 45.0% had complicated fistulae.…”

Section: Discussionmentioning

confidence: 99%

Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute’s perspective

Vikram,

Om Kumar,

Arjun Singh

et al. 2024

Urologia

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Introduction: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. Methods: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. Results: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Conclusion: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.

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Urinary fistula-A continuing problem with changing trends

Cited by 14 publications

References 13 publications

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

Rising trends in iatrogenic urogenital fistula: A new challenge

Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute’s perspective

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