title: Ethical aspects of urinary diversion for women with irreparable obstetric fistulas in developing countries.
abstract: Obstetric fistula formation is a catastrophic complication of prolonged obstructed labor. Obstetric fistulas are common in impoverished countries where access to maternal health care is poor. Although most fistulas can be closed successfully at the time of operation, a small number of women sustain such extensive pelvic injuries that their fistulas are irreparable. Some Western surgeons visiting African countries where fistulas are prevalent have become enthusiastic advocates of performing urinary diversions on these women, transplanting the ureters into the colon. We present a case study of one such woman with an irreparable obstetric fistula and discuss the complex ethical issues involved in considering whether to offer operations of this kind to African fistula victims.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, Campus Box 8064, 660 South Euclid Avenue, St. Louis, MO 63110, USA. WALLL@wudosis.wustl.edu
authors.forename: L Lewis
authors.initials: LL
authors.lastname: Wall
authors.forename: Steven D
authors.initials: SD
authors.lastname: Arrowsmith
authors.forename: Brian D
authors.initials: BD
authors.lastname: Hancock
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D003906:Developing Countries; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D008493:Medical Missions / Q000941:ethics; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000941:ethics*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*; D016387:Women's Health / Q000941:ethics