Obstetric fistulas: a clinical review.
A high proportion of genitourinary fistulas have an obstetric origin. Obstetric fistulas are caused by prolonged obstructed labor coupled with a lack of medical attention. While successful management with prolonged bladder drainage has occasionally been reported, mature fistulas require formal operative repair, and it is crucial that the first repair is done properly. The literature reports 3 approaches to fistula repair: vaginal, abdominal, and combined vaginal and abdominal. Many authors report high success rates for the surgical closure of obstetric fistulas at the time of hospital discharge, without further evaluation of the repair's effect on urinary continence or subsequent quality of life. Data on obstetric fistulas are scarce, and thus many questions regarding fistula management remain unanswered. A standardized terminology and classification, as well as a data reporting system on the surgical management of obstetric fistulas and its outcomes, are critical steps that need to be taken immediately.
Creanga
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Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. acreanga@jhsph.edu
Genadry
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D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006176:Gynecology / Q000379:methods; D006801:Humans; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D011247:Pregnancy; D018456:Reproductive Medicine / Q000379:methods; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*