Genitourinary reconstruction in obstetric fistulas.
Although most recent literature concerning female urinary tract fistulas has addressed the problem of postoperative and post-irradiation fistula, obstetrical fistula is more common worldwide. A series of fistula repairs predominantly caused by obstructed labor is presented. During a 30-months interval 139 procedures were performed on 98 patients with fistulas at a variety of anatomical locations or on patients with type III urinary incontinence following fistula repair. The fistulas were caused by obstructed labor in 94.9% of the patients. Repair was done vaginally in 110 cases, abdominally in 25 and by a combined approach in 3. Of the patients 81% were dry after 1 procedure and all but 4% were dry after multiple procedures. The subjective observations of moderate to severe vaginal scarring, or severe damage to the urethra or bladder neck were the best predictors of adverse outcome.
Department of Urology, Medical College of Ohio, Toledo 43699.
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Arrowsmith
D000328:Adult; D005260:Female; D005402:Fistula / Q000601:surgery; D006801:Humans; D012006:Rectovaginal Fistula / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000601:surgery; D014548:Urinary Fistula / Q000601:surgery; D014591:Uterine Diseases / Q000601:surgery; D014624:Vaginal Fistula / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*