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Journal of Medical Case Reports Sep 2021Ascaris in urinary bladder is an extremely rare phenomenon. It may occur after fistula formation between urinary and gastrointestinal tract or by retrograde migration of...
INTRODUCTION
Ascaris in urinary bladder is an extremely rare phenomenon. It may occur after fistula formation between urinary and gastrointestinal tract or by retrograde migration of adult worm, and is associated with complications.
CASE PRESENTATION
A 47-year-old Amhara woman from rural northwest Ethiopia presented with a complaint of difficulty to fully evacuate her bladder of 1 year duration. Ultrasonography showed thickened bladder wall with echo debris. There were also thickened bowel and fluid-filled loops of intestine adjacent to urinary bladder. On cystoscopy examination, there was live ascaris swimming inside the bladder. Enterovesical fistula was entertained and explorative laparotomy performed. Findings confirmed presence of iliovesical fistula. The fistula was divided and the continuity of the intestine restored. The inflammatory mass was subjected to histopathology study and turned out to be benign inflammatory reaction. She was also given antihelminthics. Postoperatively, her course was uneventful, and she was discharged cured.
CONCLUSION
Though it is extremely rare to have urinary symptoms from ascariasis, it is important to have a high index of suspicion for all possibilities.
Topics: Animals; Ascariasis; Ascaris; Ethiopia; Female; Humans; Intestinal Fistula; Middle Aged; Urinary Bladder
PubMed: 34587991
DOI: 10.1186/s13256-021-03045-4 -
BMC Women's Health May 2021The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences...
BACKGROUND
The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair.
METHODS
Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019-October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance.
RESULT
The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains.
CONCLUSION
The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.
Topics: Academic Medical Centers; Ethiopia; Female; Fistula; Humans; Obstetrics; Pregnancy; Prospective Studies; Quality of Life; Vesicovaginal Fistula
PubMed: 34020632
DOI: 10.1186/s12905-021-01360-y -
International Braz J Urol : Official... 2020Several methods and techniques have been described for the treatment of vesicovaginal fistula (VVF) including abdominal, vaginal and endoscopic approaches. The...
INTRODUCTION AND OBJECTIVE
Several methods and techniques have been described for the treatment of vesicovaginal fistula (VVF) including abdominal, vaginal and endoscopic approaches. The development of laparoscopic surgery minimizes the morbidity associated with laparotomy, reducing the period of convalescence, being increasingly used in the management of VVF. This aim of this study is to present 42 cases of laparoscopic vesicovaginal fistula repair and to evaluate their results.
MATERIALS AND METHODS
Forty-two patients with a diagnosis of VVF between 1998 and 2016 were included, with precise indications of abdominal surgical approach as recommended by Lee et al. (1) Cystoscopy, Retrograde urethrocystography and excretory urography confirmed the presence of VVF and ruled out ureteral lesions in all patients.
RESULTS
Forty-two patients with VVF, mean age of 40.35 years (19-75 years), were treated. The most frequent cause of VVF was abdominal hysterectomy (80.95%) 34 patients (80.95%) had never been treated, while 7 patients (16.66%) had undergone unsuccessful abdominal surgical treatment. One patient (2.38%) underwent three attempts of correction, one vaginally and two abdominal without success. The average time of hospitalization was 3 days. The average duration of the vesical catheter was 12 days. Complications occurred in 4 patients (9.52%). Only 2 patients (4.76%) had recurrence at 40 and 90 days after their first surgery, both of them were previously submitted to radiotherapy.
CONCLUSION
The laparoscopic approach of VVF is an excellent alternative to the traditional abdominal approach. Therefore, it is a feasible, effective and minimally invasive method that can treat this entity.
Topics: Adult; Aged; Female; Humans; Laparoscopy; Middle Aged; Treatment Outcome; Vesicovaginal Fistula; Young Adult
PubMed: 32022529
DOI: 10.1590/S1677-5538.IBJU.2018.0743 -
African Health Sciences Sep 2017Obstetric fistula is a maternal morbidity creating devastating health problems for the women. Continuous and uncontrollable leaking of urine or faeces from vagina can...
BACKGROUND
Obstetric fistula is a maternal morbidity creating devastating health problems for the women. Continuous and uncontrollable leaking of urine or faeces from vagina can lead to life changing stigmatization for women in third world countries. The underlying factors and consequences of this problem are not yet fully identified and adequately documented in Ethiopia.
METHODS
This study is based on the Ethiopian Demographic and Health Survey data (EDHS, 2005). The survey collected information on a total of 14,070 women who were interviewed face to face on their background characteristics as well as reproductive health issues, out of which 3178 women had complete measurements and were considered in this study. Descriptive and binary logistic regressions techniques were used using demographic, socio-economic, health and environmental related variables as explanatory variables and status of obstetric fistula as a response variable.
RESULTS
The results showed that geographical region, place of residence, educational status, age at first birth, age at first marriage, employment status, place of delivery and follow up of antenatal care during pregnancy were significant determinant factors of obstetric fistula in Ethiopia.
CONCLUSION
The study showed that demographic, socio-economic, environmental and health related variables have an import ant effect on determinants of obstetric fistula in Ethiopia.
Topics: Adolescent; Adult; Ethiopia; Female; Health Surveys; Humans; Interviews as Topic; Logistic Models; Obstetric Labor Complications; Pregnancy; Prevalence; Residence Characteristics; Risk Factors; Surveys and Questionnaires; Vesicovaginal Fistula; Young Adult
PubMed: 29085394
DOI: 10.4314/ahs.v17i3.9 -
Experimental and Therapeutic Medicine Aug 2022Radical cystectomy is the gold standard treatment for muscular invasive bladder cancer. Bricker surgery is the most common technique used for urinary diversion; however,...
Radical cystectomy is the gold standard treatment for muscular invasive bladder cancer. Bricker surgery is the most common technique used for urinary diversion; however, troublesome complications such as postoperative anastomotic stenosis or fistula may occur. The case of a patient who had a urinary fistula after Bricker surgery performed at our hospital, is described. The patient was successfully treated with continuous double-cannula negative-pressure drainage and avoided a second surgery. The patient recovered well and is on regular follow-up. This case highlights the importance of timely and relevant treatment for patients with postoperative urinary fistula to avoid more invasive surgery.
PubMed: 35837074
DOI: 10.3892/etm.2022.11418 -
International Journal of Women's Health 2016To examine the incidence and type of obstetric fistula presenting to Hamlin Fistula Ethiopia over a 4-year period.
OBJECTIVE
To examine the incidence and type of obstetric fistula presenting to Hamlin Fistula Ethiopia over a 4-year period.
STUDY DESIGN
This is a 4-year retrospective survey of obstetric fistula treated at three Hamlin Fistula Hospitals in Ethiopia, where approximately half of all women in the country are treated. The operation logbook was reviewed to identify all new cases of obstetric fistula presenting from 2011 to 2015. New cases of urinary fistula were classified by fistula type (high or low), age, and parity of the woman.
RESULTS
In total, 2,593 new cases of urinary fistulae were identified in the study period. The number of new cases fell by 20% per year over the 4 years (P<0.001). A total of 1,845 cases (71.1%) were low (ischemic) fistulae, and 804 cases (43.6%) of these had an extreme form of low circumferential fistula. A total of 638 (24.6%) women had a high bladder fistula, which predominantly occurs following surgery, specifically cesarean section or emergency hysterectomy, and 110 (4.2%) women had a ureteric fistula. The incidence of high fistulae increased over the study period from 26.9% to 36.2% (P<0.001). A greater proportion of multiparous women had a high bladder fistula (70.3%) compared with primigravid women (29.7%) (P<0.001). Conversely, a greater proportion of primiparous women experienced a low circumferential fistulae (68.6%) compared with multiparous women (31.4%) (P<0.001).
CONCLUSION
There appears to be a decline in the number of Ethiopian women being treated for new obstetric urinary fistulae. However, the type of fistula being presented for treatment is changing, with a rise in high fistulae that very likely occurred following cesarean section and a decline in the classic low fistulae that arise following obstructed childbirth.
PubMed: 27445505
DOI: 10.2147/IJWH.S106645 -
International Braz J Urol : Official... 2015The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a...
OBJECTIVE:
The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula.
MATERIALS AND METHODS:
Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion.
RESULTS:
The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery.
DISCUSSION:
Laparoscopy has advantages over open surgery in that it is associated with less pain, shorter length of hospital stay, better cosmesis, quicker recovery, and equal efficacy. Although cases of VUF are rarely noted, the laparoscopic skill obtained through other urological procedures suggest, that laparoscopic repair may be the procedure of choice for such cases (2). The reported operative time for the laparoscopic repair of VUF in the literature varies between 140 and 220 min (3). However, laparoscopic techniques should be considered as a mode of abdominal access and should not influence the method of surgical repair. Surgical success should depend on the adherence to good technique rather than the approach. Hence, this method appears to be a viable alternative for surgeons experienced with laparoscopic suturing techniques.
CONCLUSION:
Laparoscopic repair appears to be a viable alternative for surgeons experienced with laparoscopic suturing techniques.
Topics: Adult; Cesarean Section; Female; Fistula; Humans; Laparoscopy; Operative Time; Treatment Outcome; Urinary Bladder Fistula; Uterine Diseases
PubMed: 26689504
DOI: 10.1590/S1677-5538.IBJU.2014.0391 -
Archivos Espanoles de Urologia Mar 2020In the laparoscopic/robotic repair (L/R R) of Vesico-vaginal Fistulas (VVF) two types of transvesical and extravesical approaches are used.However, no direct comparisons...
OBJECTIVE
In the laparoscopic/robotic repair (L/R R) of Vesico-vaginal Fistulas (VVF) two types of transvesical and extravesical approaches are used.However, no direct comparisons exist between both surgical approaches Moreover, a lack of clinical guidelines is currently ongoing. Therefore, the selection of the type of approach is based on the preferences of the surgeon without considering the characteristics of each case.In order to provide recommendations for the selection of the appropriate technique for each patient, we designed a study that identifies and evaluates differences between the Transvesical and Extravesical approaches in the L/R R of the VVF.
PATIENTS AND METHODS
A total of 9 patients withVVF were included. Four patients underwent transvesicaltechnique and the rest the Extravesical technique. Thevariables in each group were recorded. Surgical stepswere selected with technical differences to be analyzed(identification of the fistula, dissection of the vesico-vaginalplane, cystotomy, maneuvers of exposure and cystorrhaphy).
RESULTS
Short operative times and catheterization times were recorded in the Extravesical approach. Intraoperative blood loss was minimal in both groups, the hospital stay was very similar and no peri and post-operativec omplications were reported. In all cases the fistula was resolved and there have been no recurrences in a mean follow-up of 35 months. Technically, Extravesical approach minimizes the size of the cystotomy, decreases suture time, does not require maneuvers for adequate exposure, and simplifies cystorrhaphy with respect to Transvesical technique, at the expense of requiring further dissection and having a slight difficulty in locating the fistula. Transvesical technique simplifies the locationof the fistula and allows better intravesical visualization.
CONCLUSION
In the L/R R of the VVF, the Extravesicaltechnique offers technical and perioperative advantages,so it must be the technique of choice for most VVFwith indication of abdominal approach. Transvesicaltechnique should be reserved for recurrent, recurrent,inflammatory fistulas, with difficulties identifying the fistulous orifice, close to ureteric orifice and with imminent need for ureteral reimplantation.
Topics: Female; Humans; Laparoscopy; Operative Time; Robotic Surgical Procedures; Treatment Outcome; Ureter; Vesicovaginal Fistula
PubMed: 32124839
DOI: No ID Found -
BMJ Open Mar 2024Obstetric fistula is a devastating childbirth injury primarily caused by prolonged, obstructed labour. It leaves women incontinent, severely stigmatised and isolated.... (Observational Study)
Observational Study
Patient characteristics, surgery outcomes, presumed aetiology and other characteristics of fistula surgeries and related procedures supported by Fistula Foundation from 2019 to 2021: a multicentre, retrospective observational study.
OBJECTIVES
Obstetric fistula is a devastating childbirth injury primarily caused by prolonged, obstructed labour. It leaves women incontinent, severely stigmatised and isolated. Fistula repair surgery can restore a woman's health and well-being. Fistula Foundation, a non-profit organisation, works in partnership with local hospitals and community organisations in Africa and Asia to address key barriers to treatment and to increase the number of women receiving surgical care. This paper presents data on fistula and fistula repair surgery across a large global network of hospitals supported by Fistula Foundation. The data were collected between 2019 and 2021.
DESIGN
Multicentre, retrospective, observational, descriptive study.
SETTING AND PARTICIPANTS
The study analysed deidentified data from 24 568 surgical repairs supported by Fistula Foundation to treat women with obstetric fistula at 110 hospitals in 27 countries.
RESULTS
The data highlight patient characteristics and key trends and outcomes from obstetric fistula repair surgeries and related procedures. Of those surgeries, 87% resulted in a successful outcome (fistula dry and closed) at the time of discharge, highlighting the effectiveness of fistula repair in restoring continence and improving quality of life. Over the period studied, the number of supported surgeries increased by 14%, but there remains an urgent need to strengthen local surgical capacity and improve access to treatment. Women suffered an average of 5.7 years before they received surgery and only 4% of women sought care independently. This underscores the importance of enhancing community awareness and strengthening referral networks.
CONCLUSIONS
This research provides essential insight from a vast, global network of hospitals providing highly effective fistula repair surgery. Further investment is needed to strengthen surgical capacity, increase awareness of fistula and remove financial barriers to treatment if stakeholders are to make significant progress towards the United Nations' ambitious vision of ending fistula by 2030.
Topics: Pregnancy; Female; Humans; Vesicovaginal Fistula; Retrospective Studies; Quality of Life; Obstetric Surgical Procedures; Dystocia
PubMed: 38485171
DOI: 10.1136/bmjopen-2023-078426 -
Tropical Medicine & International... Sep 2022We sought to document outcomes and factors associated with surgical success in hospitals supported by the Fistula Care Plus Project in the Democratic Republic of Congo...
OBJECTIVE
We sought to document outcomes and factors associated with surgical success in hospitals supported by the Fistula Care Plus Project in the Democratic Republic of Congo (DRC), 2017-2019.
METHODS
This was a retrospective cohort study analysing routine repair data on women with Female Genital Fistula. Univariate and multivariate analyses were conducted to determine factors associated with successful fistula repair.
RESULTS
A total of 895 women were included in this study, with a mean age of 34 years (±13 years). The majority were married or in union (57.4%) and living in rural areas (82.0%), while nearly half were farmers (45.9%). The average duration living with fistula was 8 years (±7). Vesicovaginal (70.5%) and complex (59.8%) fistulas were the most common fistula types. Caesarean section (34.7%), obstructed labour (27.0%) and prolonged labour (23.0%) were the main aetiologies, with the causal deliveries resulting in stillbirth in 88% of cases. The vaginal route (74.9%) was the primary route for surgical repair. The median duration of bladder catheterization after surgery was 14 days (interquartile range [IQR] 7-21). Multivariate analysis revealed that Waaldijk type I fistula (adjusted odds ratio [aOR]:2.71, 95% confidence interval [CI]:1.36-5.40), no previous surgery (aOR:2.63, 95% CI:1.43-3.19), repair at Panzi Hospital (aOR: 2.71, 95% CI:1.36-5.40), and bladder catheterization for less than 10 days (aOR:13.94, 95% CI: 4.91-39.55) or 11-14 days (aOR: 6.07, 95% CI: 2.21-15.31) were associated with better repair outcomes.
CONCLUSION
The Fistula Care Plus Project in the DRC recorded good fistula repair outcomes. However, further efforts are needed to promote adequate management of fistula cases.
Topics: Adult; Cesarean Section; Democratic Republic of the Congo; Female; Genitalia, Female; Humans; Pregnancy; Retrospective Studies; Vesicovaginal Fistula
PubMed: 35749231
DOI: 10.1111/tmi.13794