Advertisement

Obstetric Fistula

Chapter

Abstract

Obstetric fistula is common in developing countries as a result of unattended prolonged obstructed labour. Evaluation of obstetric fistula is based on history and clinical examination. Continuous urinary or stool leakage started soon after a long labour that ended usually with stillbirth in a low resource area is highly suggestive of obstetric fistula. To date, there is no consensus regarding the classification of obstetric fistula. Multiple classification systems have been proposed, but all the present classifications of obstetric fistula are of limited clinical use because of the lack of impact on treatment outcome. Surgical treatment with closure of fistulous tract and reconstruction of local anatomy is the mainstay of therapy. Persistent urinary incontinence after successful surgical repair is the most concerning problem; additional continence surgery is usually needed. In experienced hands, the success rate of surgery varies around 80–90 % after the first surgical repair. Postoperative care should be focused on appropriate bladder drainage and early identification of complications.

Keywords

Obstetric fistula Obstructed labour Urinary incontinence Low-resource area Incontinence surgery Fistula recurrence Continuous bladder drainage 

References

  1. 1.
    Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross-sectional study. Am J Obstet Gynecol. 2004;192:342–9.CrossRefGoogle Scholar
  2. 2.
    Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374:881–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Harrison KA. Child-bearing, health and social priorities: a survey of 22, 774 consecutive hospital births in Zaria, Northern Nigeria. Br J Obstet Gynaecol. 1985;92 Suppl 5:1–119.PubMedGoogle Scholar
  4. 4.
    United Nations Population Fund and Engender Health. Obstetric fistula needs assessment report: findings from nine African countries. New York: United Nations Population Fund and Engender Health; 2003.Google Scholar
  5. 5.
    Kelly J, Kwast BE. Epidemiological study of vesico-vaginal fistulas in Ethiopia. Int Urol J. 1993;4:278–81.Google Scholar
  6. 6.
    Wall LL, Karshima JA, Kirschner C, Arrowsmith SD. The obstetric vesicovaginal fistula: characteristics of 899 patients from Jos, Nigeria. Am J Obstet Gynecol. 2004;190:1011–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Browning A. Urogenital fistulae – obstetric, Chapter 89. In: Cardozo L, Staskin D, editors. Textbook of female urology and urogynecology, vol. 2. Boca Raton: Informa Healthcare; 2006.Google Scholar
  8. 8.
    Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv. 1996;51(9):568–74.CrossRefPubMedGoogle Scholar
  9. 9.
    Browning A. Prevention of residual urinary incontinence following successful repair of obstetric vesico-vaginal fistula using a fibro-muscular sling. BJOG. 2004;111(4):357–61.CrossRefPubMedGoogle Scholar
  10. 10.
    Frajzyngier V, Ruminjo J, Barone MA. Factors influencing urinary fistula repair outcomes in developing countries: a systematic review. Am J Obstet Gynecol. 2012;207(4):248–58. doi: 10.1016/j.ajog.2012.02.006. Epub 2012 Feb 20.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Benchekroun A, Lachkar A, Soumana A, Farih MH, Belahnech Z, Marzouk M, Faik M. Uretero-vaginal fistulas. 45 cases. Ann Urol (Paris). 1998;32(5):295–9.Google Scholar
  12. 12.
    Tazi K, el Fassi J, Karmouni T, Koutani A, Ibn Attya AI, Hachimi M, et al. Vesico-uterine fistula. Report of 10 cases. Prog Urol. 2000;10(6):1173–6.PubMedGoogle Scholar
  13. 13.
    Tebeu PM, Fomulu JN, Khaddaj S, de Bernis L, Delvaux T, Rochat CH. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23(4):387–94. doi: 10.1007/s00192-011-1622-x. Epub 2011 Dec 6.CrossRefPubMedGoogle Scholar
  14. 14.
    Lagundoye SB, Bell D, Gill G, Ogunbode O. Urinary tract changes in obstetric vesico-vaginal fistulae: a report of 216 cases studied by intravenous urography. Clin Radiol. 1976;27(4):531–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Aimaku VE. Reproductive functions after the repair of obstetric vesicovaginal fistulae. Fertil Steril. 1974;25:586–91.CrossRefGoogle Scholar
  16. 16.
    Evoh NJ, Akinla O. Reproductive performance after the repair of obstetric vesico-vaginal fistulae. Ann Clin Res. 1978;10(6):303–6.PubMedGoogle Scholar
  17. 17.
    Browning A. Pregnancy following obstetric fistula repair, the management of delivery. BJOG. 2009;116(9):1265–7. doi: 10.1111/j.1471-0528.2009.02182.x. Epub 2009 May 11.CrossRefPubMedGoogle Scholar
  18. 18.
    Mselle LT, Moland KM, Evjen-Olsen B, Mvungi A, Kohi TW. “I am nothing”: experiences of loss among women suffering from severe birth injuries in Tanzania. BMC Womens Health. 2011;11:49. doi: 10.1186/1472-6874-11-49.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Goh JT, Sloane KM, Krause HG, Browning A, Akhter S. Mental health screening in women with genital tract fistulae. BJOG. 2005;112(9):1328–30.CrossRefPubMedGoogle Scholar
  20. 20.
    Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet. 2006;368:1201–9.CrossRefPubMedGoogle Scholar
  21. 21.
    WHO. Obstetric fistula – Guiding principles for clinical management and programme development –Department of Making Pregnancy Safer; 2006.Google Scholar
  22. 22.
    Waaldijk K. Surgical classification of obstetric fistula. Int J Gynecol Obstet. 1995;49:161–3.CrossRefGoogle Scholar
  23. 23.
    Goh JT. A new classification for female genital tract fistula. Aust N Z J Obstet Gynecol. 2004;44(6):502–4.CrossRefGoogle Scholar
  24. 24.
    Wall LL, Arrowsmith SD, Briggs ND, Browning A, Lassey AT. The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Survey. 2005;60 Suppl 1:S1–51.Google Scholar
  25. 25.
    Frajzyngier V. Toward a better understanding of urinary fistula repair prognosis: results from a multi-country prospective cohort study. Columbia University, Department of Epidemiology: Dissertation; 2011.Google Scholar
  26. 26.
    Waaldijk K. The immediate management of fresh obstetric fistulas. Am J Obstet Gynecol. 2004;191(3):795–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Singh O, Gupta SS, Mathur RK. Urogenital fistulas in women: 5-year experience at a single center. Urol J. 2010;7(1):35–9.PubMedGoogle Scholar
  28. 28.
    Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. 2001;11(4):417–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Schlunt Eilber K, Rosenblum N, Rodriguez L. Chapter 53 – Vesicovaginal Fistula: Complex Fistulae. In: Vasavada SP, editor. Female urology, urogynecology and voiding dysfunction. New York: Marcel Dekker; 2005. p. 761–82.Google Scholar
  30. 30.
    Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, Bello A, Danladi D, et al. Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study. BJOG. 2012;119(11):1344–53.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Evans DH, Madjar S, Politano VA, Bejany DE, Lynne CM, Gousse AE. Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology. 2001;57:670–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Rangnekar NP, Imdad Ali N, Kaul SA, Pathak HR. Role of the martius procedure in the management of urinary-vaginal fistulas. J Am Coll Surg. 2000;191(3):259.CrossRefPubMedGoogle Scholar
  33. 33.
    Browning A. Lack of value of the Martius fibrofatty graft in obstetric fistula repair. Int J Gynaecol Obstet. 2006;93(1):33.CrossRefPubMedGoogle Scholar
  34. 34.
    Wall LL. Obstetric fistulas in resource-limited settings. UpToDate, last updated Oct 2013.Google Scholar
  35. 35.
    Goh JT, Krause H, Tessema AB, Abraha G. Urinary symptoms and urodynamics following obstetric genitourinary fistula repair. Int Urogynecol J. 2013;24(6):947–51. Epub 2012 Oct 25.CrossRefPubMedGoogle Scholar
  36. 36.
    Ascher-Walsh CJ, Capes TL, Lo Y, Idrissa A, Wilkinson J, Echols K, et al. Sling procedures after repair of obstetric vesicovaginal fistula in Niamey, Niger. Int Urogynecol J. 2010;21(11):1385.CrossRefPubMedGoogle Scholar
  37. 37.
    Goh JT, Browning A. Use of urethral plugs for urinary incontinence following fistula repair. Aust N Z J Obstet Gynaecol. 2005;45(3):237.CrossRefPubMedGoogle Scholar
  38. 38.
    Hamlin RHJ, Nicholson EC. Reconstruction of urethra totally destroyed in labour. Br Med J. 1969;2(5650):147–50.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Patwardhan SK, Sawant A, Ismail M, Nagabhushana M, Varma RR. Simultaneous bladder and vaginal reconstruction using ileum in complicated vesicovaginal fistula. Indian J Urol. 2008;24(3):348–51. doi: 10.4103/0970-1591.39546.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kelly J. Vesico-vaginal and recto-vaginal fistulae. J R Soc Med. 1992;85(5):257–8.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Arrowsmith SD, Barone MA, Ruminjo J. Outcomes in obstetric fistula care: a literature review. Curr Opin Obstet Gynecol. 2013;25(5):399–403. doi: 10.1097/GCO.0b013e3283648d60.CrossRefPubMedGoogle Scholar
  42. 42.
    Barone MA, Frajzyngier V, Ruminjo J, et al. Determinants of postoperative outcomes of female genital fistula repair surgery. Obstet Gynecol. 2012;120:524–31.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Browning A, Menber B. Women with obstetric fistula in Ethiopia: a 6-month follow up after surgical treatment. BJOG. 2008;115:1564–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Rijken Y, Chilopora GC. Urogenital and recto-vaginal fistulas in Southern Malawi: a report on 407 patients. Int J Gynaecol Obstet. 2007;99:S85–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Rafique M. Genitourinary fistulas of obstetric origin. Int Urol Nephrol. 2002–2003;34(4):489–93.Google Scholar
  46. 46.
    Husain A, Johnson K, Glowacki CA, Osias J, Wheeless Jr CR, Asrat K, et al. Surgical management of complex obstetric fistula in Eritrea. J Womens Health (Larchmt). 2005;14(9):839–44.CrossRefGoogle Scholar
  47. 47.
    Arrowsmith SD. Genitourinary reconstruction in obstetric fistulas. J Urol. 1994;152(2 Pt 1):403–6.PubMedGoogle Scholar
  48. 48.
    Kliment J, Beráts T. Urovaginal fistulas: experience with the management of 41 cases. Int Urol Nephrol. 1992;24(2):119–24.CrossRefPubMedGoogle Scholar
  49. 49.
    Kayondo M, Wasswa S, Kabakyenga J, Mukiibi N, Senkungu J, Stenson A, et al. Predictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda. BMC Urol. 2011;11:23. doi: 10.1186/1471-2490-11-23.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Chigbu CO, Nwogu-Ikojo EE, Onah HE, Iloabachie GC. Juxtacervical vesicovaginal fistulae: outcome by route of repair. J Obstet Gynaecol. 2006;26(8):795–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Morhason-Bello IO, Ojengbede OA, Adedokun BO, Okunlola MA, Oladokun A. Uncomplicated midvaginal vesico-vaginal fistula repair in Ibadan: a comparison of the abdominal and vaginal routes. Ann Ib Postgrad Med. 2008;6:39–43.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Hilton P. Urogenital fistula in the UK: a personal case series managed over 25 years. BJU Int. 2012;110(1):102–10. doi: 10.1111/j.1464-410X.2011.10630.x. Epub 2011 Oct 7.CrossRefPubMedGoogle Scholar
  53. 53.
    Browning A. The circumferential obstetric fistula: characteristics, management and outcomes. BJOG. 2007;114(9):1172–6. Epub 2007 Jul 6.CrossRefPubMedGoogle Scholar
  54. 54.
    Nardos R, Menber B, Browning A. Outcome of obstetric fistula repair after 10-day versus 14-day Foley catheterization. Int J Gynaecol Obstet. 2012;118(1):21–3. doi: 10.1016/j.ijgo.2012.01.024. Epub 2012 Apr 28.CrossRefPubMedGoogle Scholar
  55. 55.
    Browning A. A new technique for the surgical management of urinary incontinence after obstetric fistula repair. BJOG. 2006;113(4):475–8. Epub 2006 Feb 20.CrossRefPubMedGoogle Scholar
  56. 56.
    Carey MP, Goh JT, Fynes MM, Murray CJ. Stress urinary incontinence after delayed primary closure of genitourinary fistula: a technique for surgical management. Am J Obstet Gynecol. 2002;186:948–53.CrossRefPubMedGoogle Scholar
  57. 57.
    Garely AD, Mann WJ Jr. Urogenital tract fistulas in women. UpToDate, last updated: 10 Sep 2013.Google Scholar

Copyright information

© Springer-Verlag London 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology“Carol Davila” University of Medicine and Pharmacy Filantropia Clinical HospitalBucharestRomania

Personalised recommendations