Vesicovaginal fistula revisited.

摘要: Vesicovaginal fistulas remain a common problem in developing countries where access to adequate health care is limited. This paper reviews series of 36 surgical repairs (29 primary and 7 recurrent fistulas) performed by visiting US gynecologists 1978-87 at medical centers West Africa. The 2 most commonly observed types this series--1-2 cm the proximal urethra/bladder neck (14 cases) 4 or greater involving bladder fundus and/or (12 cases)--generally follow neglected obstetric labor with without cesarean section. Urinary leakage continued despite attempts repair 11 patients for an overall success rate 70%. failure was highest (50%) cases large (4 greater); contrast on small (102 cm) only 8%. Success rates improved over time however as more appropriate procedures were selected operator experience increased. Until 1987 excision fistula tract freshening edges larger defects used techniques. At it discovered that case mobilization could be markedly enhanced making radial circumferential incisions through vaginal mucosa away from thus creating flaps mobilized mucosa. Use procedure reduced 75% 1986 25% 1987. Postoperative complications included severe stress urinary incontinence after urethral (2 temporary unstable (several blood loss than 500 ml (1 case).