title: Surgical classification of obstetric fistulas.
abstract: OBJECTIVE
  To develop a surgical classification for obstetric fistulas in order to compare surgical techniques and results.
  
  
  METHODS
  Based on a retrospective analysis of 775 consecutive fistula patients, the following classification is presented: (type I) fistulas not involving the urethral closing mechanism; (type II) fistulas involving the urethral closing mechanism; and (type III) ureter and other exceptional fistulas. Type II fistulas can be further divided into: (A) without (sub)total urethra involvement, and (B) with (sub)total urethra involvement; and (a) without a circumferential defect, and (b) with a circumferential defect. This classification was applied prospectively in over 2700 consecutive fistula patients.
  
  
  RESULTS
  The surgical technique becomes progressively more complicated from type I through type IIBb. The results of closure and continence worsen progressively from type I through type IIBb. Personal experience in the case of type III fistulas is very limited.
  
  
  CONCLUSIONS
  This classification enables a systematic comparison of different surgical techniques and an objective evaluation of results from different centers.
authors.affiliation: Laure Fistula Center, Murtala Muhammad Specialist Hospital, Kano, Nigeria.
authors.forename: K
authors.initials: K
authors.lastname: Waaldijk
mesh_terms: D000328:Adult; D003906:Developing Countries; D005260:Female; D006801:Humans; D009549:Nigeria; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000145:classification* / Q000601:surgery; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000145:classification / Q000601:surgery; D014548:Urinary Fistula / Q000145:classification* / Q000601:surgery; D014549:Urinary Incontinence / Q000145:classification / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000145:classification* / Q000601:surgery