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INTRODUCTION AND HYPOTHESIS: We evaluated a pilot multi-component reintegration intervention to improve womens physical and psychosocial quality of life after genital fistula surgery. METHODS: Twelve women undergoing fistula repair at Mulago Specialized Women and Neonatal Hospital (Kampala, Uganda) anticipated in a 2-week multi-component intervention including health education, psychosocial therapy, physiotherapy, and economic investment. We assessed feasibility through recruitment, retention, and adherence, acceptability through intervention satisfaction, and preliminary effectiveness through reintegration, mental health, physical health, and economic status. We collected quantitative data at enrollment, 6 weeks, 3 months, and 6 months. We conducted in-depth interviews with six participants. Quantitative data are presented descriptively, and qualitative data analyzed thematically. RESULTS: Participants had a median age of 34.5 years (25.5-38.0), 50% were married/partnered, 42% were separated, 50$ had completed less than primary education, and 67% were unemployed. Mean number of sessions received was 12 for health education (range 5-15), 8 for counseling (range 8-9), and 6 for physiotherapy (range 4-8). Feasibility was demonstrated by study acceptance among all those eligible (100%); comfort with study measures, data collection frequency and approach; and procedural fidelity. Acceptability was high; all participants reported being very satisfied with the intervention and each of the components. Participant narratives echoed quantitative findings and contributed nuanced perspectives to understanding approach and content. CONCLUSIONS: Our results suggest that the intervention and associated research were both feasible and acceptable, and suggested certain modifications to the intervention protocol to reduce participant burden. Further research to determine the effectiveness of the intervention above and beyond surgery alone with regard to the health and well-being of

An obstetric fistula is a hole between the birth canal and the bladder or rectum, which is caused by prolonged, obstructed labour without intervention. Sufferers of obstetric fistula may experience chronic urinary and/or faecal incontinence. Although obstetric fistula is directly caused by prolonged obstructed labour, factors such as unskilled birth assistance can increase fistula risk indirectly. Harmful traditional practices, such as female genital mutilation, lack of formal education, illiteracy, poverty, limited social role for women, malnutrition, early marriage before the full development of the pelvis, and a lack of emergency obstetric services are some of the additional factors associated with obstructed labour and fistula formation. To understand the needs of women and implement strategies to reduce the risk factors associated with obstetric fistula, it is essential that women’s views and experiences of obstetric fistula risk factors following birth are more comprehensively understood, to inform responsive midwifery practice. The aim of this study was to explore women’s views on experiences of obstetric fistula risk factors among women attending the Evangel vesico vaginal fistula (EVVF) Centre of Bingham University Teaching Hospital (BUTH), Jos, Nigeria. This qualitative research used an interpretive descriptive design underpinned by symbolic interactionism to explore women’s views and experiences of obstetric fistula risk factors. Participants were recruited from the vesicovaginal fistula Centre of BUTH Jos Nigeria where women are admitted for ongoing obstetric fistula treatment. Data were gathered from individual face-to-face interviews using a semi-structured interview guide until data saturation was reached. Interviews were audio recorded and note-taking was undertaken to complement the data. Information was translated verbatim and thematic analysis was conducted. The findings from this study highlight the depth of Nigerian women’s views and experiences

BackgroundFistulas are an abnormal connection between two or more epithelial surfaces. When fistulization between adjacent structures occurs in the pelvis, there is almost invariably significant associated morbidity and impact on a patient's quality of life. Imaging may aid in the diagnosis of pelvic fistulas and is essential to identify any associated pathology, define the course of the fistula, and aid in pre-surgical planning.PurposeThis article aims to review the wide array of clinical and imaging presentations of fistulas in the pelvis, with a focus on the radiologists' role in managing this challenging entity.MethodsThis article will review each classification type of fistula.ResultsPelvic fistula is a devastating condition that causes significant morbidity and evaluation can be challenging.ConclusionsImaging, and particularly MRI, plays a vital role in the diagnosis, characterizing the course of a fistula and demonstrating associated complications, which are essential to guide treatment decisions.

Ileal conduit-vaginal fistulas are a rare but challenging complication of urinary diversion. Here we identify risk factors and summarize the workup and conservative management strategies for this complication. We present two cases of elderly women with remote history of cancer who presented with persistent urinary leakage from the vagina several years after ileal conduit creation. Fistulas may be identified using dye or imaging with a loopogram and looposcopy. Correction of obstruction such as stomal stenosis or urinary diversion should be pursued to relieve pressure off the conduit. Minimally invasive management such as fulguration can result temporary relief; however, the recurrence rate is high.

Ileal conduit-vaginal fistulas are a rare but challenging complication of urinary diversion. Here we identify risk factors and summarize the workup and conservative management strategies for this complication. We present two cases of elderly women with remote history of cancer who presented with persistent urinary leakage from the vagina several years after ileal conduit creation. Fistulas may be identified using dye or imaging with a loopogram and looposcopy. Correction of obstruction such as stomal stenosis or urinary diversion should be pursued to relieve pressure off the conduit. Minimally invasive management such as fulguration can result temporary relief; however, the recurrence rate is high.

ObjectivesTo explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery.MethodsWe recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results.ResultsAcross post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4).ConclusionsOur longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.

ObjectivesTo explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery.MethodsWe recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results.ResultsAcross post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4).ConclusionsOur longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.

OBJECTIVES: To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. METHODS: We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS: Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4). CONCLUSIONS: Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support womens recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.

BACKGROUND: Vaginal fistula is a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. The burden of this disorder in sub-Saharan Africa is uncertain. We estimated the lifetime and point prevalence of symptoms of vaginal fistula in this region using national household surveys based on self-report of symptoms. METHODS: We considered all Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) from sub-Saharan Africa and included data for women of reproductive age (15-49 years). We estimated lifetime prevalence and point prevalence of vaginal fistula with use of Bayesian hierarchical meta-analysis. FINDINGS: We included 19 surveys in our analysis, including 262,100 respondents. Lifetime prevalence was 3.0 cases (95% credible interval 1.3-5.5) per 1000 women of reproductive age. After imputation of missing data, point prevalence was 1.0 case (0.3-2.4) per 1000 women of reproductive age. Ethiopia had the largest number of women who presently have symptoms of vaginal fistula. INTERPRETATION: This study is the first to estimate the burden of vaginal fistula in 19 sub-Saharan Africa countries using nationally representative survey data. Point prevalence was slightly lower than previously estimated but these earlier estimates are within the prevalence's credible intervals. Although vaginal fistula is relatively rare, it is still too common in sub-Saharan Africa. FUNDING: None.

Complete bladder eversion is rare. A case of bladder eversion trough vesicovaginal fistula accompanied with concomitant uterovaginal prolapse is presented. A 70 year-old patients presented a tumor compatible with vaginal prolapse type IV and an edematous, sticky and piriform tumor ahead of prolapse compatible with bladder with an orifice on anterior wall of vagina through bladder mucosa was everted, proceeding to reduction and manual correction of eversion and then was surgical corrected., La eversión vesical completa es rara. Se presenta el caso de una eversión de vejiga urinaria a través de una fístula vesicovaginal acompañada de prolapso útero-vaginal concurrente. Se trata de paciente de 70 años que presentó una tumoración compatible con un prolapso vaginal grado IV y una tumoración edematosa, pegajosa y piriforme por delante del prolapso compatible con la vejiga con un orificio en la pared anterior de la vagina a través del cual la mucosa de la vejiga estaba evertida, procediendo al reposicionamiento y corrección manual de la eversión para luego ser corregida quirúrgicamente.

Complete bladder eversion is rare. A case of bladder eversion trough vesicovaginal fistula accompanied with concomitant uterovaginal prolapse is presented. A 70 year-old patients presented a tumor compatible with vaginal prolapse type IV and an edematous, sticky and piriform tumor ahead of prolapse compatible with bladder with an orifice on anterior wall of vagina through bladder mucosa was everted, proceeding to reduction and manual correction of eversion and then was surgical corrected., La eversión vesical completa es rara. Se presenta el caso de una eversión de vejiga urinaria a través de una fístula vesicovaginal acompañada de prolapso útero-vaginal concurrente. Se trata de paciente de 70 años que presentó una tumoración compatible con un prolapso vaginal grado IV y una tumoración edematosa, pegajosa y piriforme por delante del prolapso compatible con la vejiga con un orificio en la pared anterior de la vagina a través del cual la mucosa de la vejiga estaba evertida, procediendo al reposicionamiento y corrección manual de la eversión para luego ser corregida quirúrgicamente.

Complete bladder eversion is rare. A case of bladder eversion trough vesicovaginal fistula accompanied with concomitant uterovaginal prolapse is presented. A 70 year-old patients presented a tumor compatible with vaginal prolapse type IV and an edematous, sticky and piriform tumor ahead of prolapse compatible with bladder with an orifice on anterior wall of vagina through bladder mucosa was everted, proceeding to reduction and manual correction of eversion and then was surgical corrected., La eversión vesical completa es rara. Se presenta el caso de una eversión de vejiga urinaria a través de una fístula vesicovaginal acompañada de prolapso útero-vaginal concurrente. Se trata de paciente de 70 años que presentó una tumoración compatible con un prolapso vaginal grado IV y una tumoración edematosa, pegajosa y piriforme por delante del prolapso compatible con la vejiga con un orificio en la pared anterior de la vagina a través del cual la mucosa de la vejiga estaba evertida, procediendo al reposicionamiento y corrección manual de la eversión para luego ser corregida quirúrgicamente.

Childbirth entails considerable risk in developing countries. A prolonged labour process can cause the woman sustained injuries and lead to the death of the unborn child. Many women in Africa suffer from vaginal fistulas, causing a constant leakage of urine and/or faeces. The aim of this study was to explore and describe women's experiences of living with fistulas and how the condition affects their daily life. An ethnographic-inspired design involving observation, group- and individual conversations, was carried out at a gynaecological ward at a rural hospital in Liberia with 14 women. The reflexive analysis during fieldwork revealed two main themes in the women's experiences: absence and reliance. The results demonstrate that the women felt a loss of control over a perceived traumatic birth, loss of the dead child, loss of status as a woman and wife and loss of social fellowship. They also felt a loss of self-confidence. In contrast, the women relied on their belief and trust in God to help them with the difficult situation.

Childbirth entails considerable risk in developing countries. A prolonged labour process can cause the woman sustained injuries and lead to the death of the unborn child. Many women in Africa suffer from vaginal fistulas, causing a constant leakage of urine and/or faeces. The aim of this study was to explore and describe women's experiences of living with fistulas and how the condition affects their daily life. An ethnographic-inspired design involving observation, group- and individual conversations, was carried out at a gynaecological ward at a rural hospital in Liberia with 14 women. The reflexive analysis during fieldwork revealed two main themes in the women's experiences: absence and reliance. The results demonstrate that the women felt a loss of control over a perceived traumatic birth, loss of the dead child, loss of status as a woman and wife and loss of social fellowship. They also felt a loss of self-confidence. In contrast, the women relied on their belief and trust in God to help them with the difficult situation.

Childbirth entails considerable risk in developing countries. A prolonged labour process can cause the woman sustained injuries and lead to the death of the unborn child. Many women in Africa suffer from vaginal fistulas, causing a constant leakage of urine and/or faeces. The aim of this study was to explore and describe women's experiences of living with fistulas and how the condition affects their daily life. An ethnographic-inspired design involving observation, group- and individual conversations, was carried out at a gynaecological ward at a rural hospital in Liberia with 14 women. The reflexive analysis during fieldwork revealed two main themes in the women's experiences: absence and reliance. The results demonstrate that the women felt a loss of control over a perceived traumatic birth, loss of the dead child, loss of status as a woman and wife and loss of social fellowship. They also felt a loss of self-confidence. In contrast, the women relied on their belief and trust in God to help them with the difficult situation.

Childbirth entails considerable risk in developing countries. A prolonged labour process can cause the woman sustained injuries and lead to the death of the unborn child. Many women in Africa suffer from vaginal fistulas, causing a constant leakage of urine and/or faeces. The aim of this study was to explore and describe women's experiences of living with fistulas and how the condition affects their daily life. An ethnographic-inspired design involving observation, group- and individual conversations, was carried out at a gynaecological ward at a rural hospital in Liberia with 14 women. The reflexive analysis during fieldwork revealed two main themes in the women's experiences: absence and reliance. The results demonstrate that the women felt a loss of control over a perceived traumatic birth, loss of the dead child, loss of status as a woman and wife and loss of social fellowship. They also felt a loss of self-confidence. In contrast, the women relied on their belief and trust in God to help them with the difficult situation.

Childbirth entails considerable risk in developing countries. A prolonged labour process can cause the woman sustained injuries and lead to the death of the unborn child. Many women in Africa suffer from vaginal fistulas, causing a constant leakage of urine and/or faeces. The aim of this study was to explore and describe women's experiences of living with fistulas and how the condition affects their daily life. An ethnographic-inspired design involving observation, group- and individual conversations, was carried out at a gynaecological ward at a rural hospital in Liberia with 14 women. The reflexive analysis during fieldwork revealed two main themes in the women's experiences: absence and reliance. The results demonstrate that the women felt a loss of control over a perceived traumatic birth, loss of the dead child, loss of status as a woman and wife and loss of social fellowship. They also felt a loss of self-confidence. In contrast, the women relied on their belief and trust in God to help them with the difficult situation.

Childbirth entails considerable risk in developing countries. A prolonged labour process can cause the woman sustained injuries and lead to the death of the unborn child. Many women in Africa suffer from vaginal fistulas, causing a constant leakage of urine and/or faeces. The aim of this study was to explore and describe women's experiences of living with fistulas and how the condition affects their daily life. An ethnographic-inspired design involving observation, group- and individual conversations, was carried out at a gynaecological ward at a rural hospital in Liberia with 14 women. The reflexive analysis during fieldwork revealed two main themes in the women's experiences: absence and reliance. The results demonstrate that the women felt a loss of control over a perceived traumatic birth, loss of the dead child, loss of status as a woman and wife and loss of social fellowship. They also felt a loss of self-confidence. In contrast, the women relied on their belief and trust in God to help them with the difficult situation.