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Aim: To present an anatomical pathogenesis parallel with the 2002 International Continence Society Lower Urinary Tract (LUTS) definitions standardization Report 2002. Methods: Each LUTS section is discussed using the same numbers as the Report. Results: Normal function Bladder control is binary, with two reflexes alternating, either closure (dominant) or open (micturition), with the same cortical and peripheral components: three directional muscle forces contracting against pubourethral (PUL) and uterosacral (USL) ligaments for closure, two against uterosacral ligaments for micturition. Dysfunction OAB symptoms reflect a prematurely activated micturition; PUL/USL weakness prevents muscle forces from controlling afferent urothelial emptying signals. Stress urinary incontinence is a consequence of weak PULs allowing posterior muscle forces to open the urethra during effort. Lax USLs weaken contractile force of the posterior urethral opening vectors, so detrusor has to contract against an unopened urethra. This is experienced as "obstructive micturition." Conclusions: Anatomical analysis indicates the ICS definitions are fundamentally sound, except for "OAB" which implies detrusor causation. Minor changes, OAB to "overactivated" bladder allow causation outside of bladder. This construct supports OAB and its component symptoms as a syndrome, as intuited by the Committee, (albeit as a prematurely activated micturition), retains the acronym, explains OAB cure by ligament repair, and incontinence pathogenesis from two post‐2002 syndromes which need an addition to the definitions, Posterior Fornix Syndrome (of which OAB is a component) and Tethered Vagina Syndrome, which is the basis for skin‐grafting cure of the 30%–50% of women who continue leaking urine massively after successful obstetric fistula closure. [ABSTRACT FROM AUTHOR]

We present a case of complete Gellhorn pessary erosion into the bladder with transvaginal removal and repair of vesicovaginal fistula. Keywords: Erosion; Pessary; Transvaginal repair; Vesicovaginal fistula EN Erosion Pessary Transvaginal repair Vesicovaginal fistula 309 311 3 01/13/23 20230101 NES 230101 Introduction The Gellhorn pessary is a commonly used space-filling pessary for the nonsurgical management of pelvic organ prolapse (POP). The vesicovaginal fistula tract was identified transvaginally and with digital manipulation the rim of the pessary was grasped, and the pessary gently removed (Fig. [Extracted from the article]

Congenital diaphragmatic hernia is a common neonatal anomaly. Presentation beyond childhood, however, is rare. We report, here, the case of a woman in her 50s who presented with an acutely obstructed posterolateral diaphragmatic hernia. The initial physical exam and radiological results could have led to an erroneous diagnosis of pneumothorax. We wish to emphasize the importance of having a high index of suspicion for this condition when cases with similar gastro-respiratory symptoms are encountered. [ABSTRACT FROM AUTHOR]

Background: Trauma to the left submandibular gland is an infrequent entity, with only a few cases reported in the literature. Recommended management consists of excision of the gland if trauma is suspected; if trauma is not clearly identified during the surgical exploration and the gland is not removed, post-traumatic complications such as fistula or sialocele may occur. In such cases, conservative measures including aspiration, pressure bandages, and anti-sialogogues are the first step of treatment and surgical excision is reserved for unsuccessful cases. Case Report: This report describes a case of post-traumatic surgical emphysema and sialocele with fistula following knife wounds to the head and neck of a 30-year-old woman. The patient had an incised wound to the left submandibular gland. Subsequently, a painful slow-growing mass developed and the diagnosis of sialocele was considered. Confirmation of this diagnosis was achieved by performing a fine-needle aspiration, which revealed a high amylase level within the collection. Afterwards, pressure bandages were applied and no recurrence of the sialocele was observed in imaging follow-up. Conclusions: This report shows that although submandibular gland trauma is rare, it can lead to salivary fistula or sialocele. The diagnosis of sialocele can be confirmed by imaging combined with fine-needle aspiration and measurement of amylase levels in the aspirate. Identification of traumatic sialocele and fistula at an early stage will lead to the most appropriate management. [ABSTRACT FROM AUTHOR]

Introduction. Childbirth is a special time in the lives of women and families at large. It can also be a time of great tragedy. International reports show that, annually, more than 500,000 women die from pregnancy and childbirth complications globally. For every woman who dies in childbirth, majorities remain alive, but scarred by permanent disabilities. Obstetric fistula is, without a doubt, the most severe of pregnancy-related disabilities. Objective. This research is aimed at assessing the long-term effects of obstetric fistula on the overall quality of life among fistula survivors in central Gondar zone. Methods. A community-based cross-sectional study was conducted among women who had undergone obstetric fistula repair, 1-4 years after the surgery, in the central Gondar zone. The participants were reached through appointments that were made by the researchers using census approach after having the participants' contact lists (specific residence and cell phone numbers), and research interviews have taken place at the respondents' home or residence using an adapted and validated tool. Data entry and analysis were done using Epi Info version 7 and SPSS version 20, respectively. Results. A total of 182 fistula survivors were interviewed giving a 94.8% response rate. This study indicated that 84.1% (95% CI: 78.8, 89.4) of respondents had a poor overall quality of life. Maternal age (>30 years) (AOR = 3.8 , 95% CI: 2.6, 12.3), marital status (divorced survivors) (AOR = 2.7 , 95% CI: 1.3, 8.5), and urinary incontinence (AOR = 1.9 , 95% CI: 2.4, 11.2) were positive predictors for poor overall quality of life. The majority of fistula survivors, 82.4%, were stigmatized which could make reintegration into the community challenging for them. Healthcare providers have to implement counseling to women for social reintegration and the possibility of gainful societal activities after repairing. [ABSTRACT FROM AUTHOR]

Rectovaginal fistula is abnormal connections between the vagina and rectum. Via this connection, the passages of flatus or stool from rectum to vagina occur. Patient history and physical examination are usually enough to make diagnosis of fistula. Although there are so many defined surgical options including sphincteroplasty, advanced flap, muscle interposition, fibrin glue, plugs, and closure of fistulas remain a challenging condition with the high rate failure of surgical repair In this study, we aim to report the results of a new treatment approach with the injection of botulinum toxin into lateral internal sphincter on the management of rectovaginal fistula in conjunction with the surgical repair. Between 2013 and 2019, 8 patients with recurrent rectovaginal fistula underwent 10 surgical repairs in conjunction with 100 units botulinum toxin injection. Results of these patients were analyzed. We have treated 8 patients with recurrent rectovaginal fistula. The etiology of fistula in our patients included obstetrical trauna (3 patients), radiotherapy and rectal surgery (2 patients), vaginal reconstruction (2 patients) and Crohn's disease (1 patient). The median number of their previous operations was 1.5 (range, 1–3). The sizes of fistulas range from 0.5 × 1 to 2 × 3 cm. In our surgical intervention, at the end, all of them were closed (100%) successfully. Botulinum toxin injection into lateral internal sphincter can be used successfully in combination with surgical intervention for the treatment of the rectovaginal fistulas. [ABSTRACT FROM AUTHOR]

Objective: The main goal of fertility-sparing treatment is pregnancy followed by live birth (i.e., successful pregnancy). The principal objective of our study was to evaluate the successful pregnancy rate in patients with borderline ovarian tumors (BOTs) after conservative treatment. The second goal was to evaluate the safety of the conservative approach.Study Design: 110 patients with BOT were retrospectively evaluated. All patients underwent surgical treatment, sparing the uterus and part of at least one ovary.Results: The median age was 28 years (range 17-40 years). Serous and mucinous tumors were found in 63 (57%) and 34 (31%) women, respectively. FIGO stage I, II, and III was diagnosed in 101 (91.8%), 3 (2.7%), and 6 (5.5%) patients, respectively. The 3- and 5-year progression-free survival was 82.5% and 78.2%, respectively. Recurrent disease was treated conservatively in 14 women, whereas 3 patients underwent radical surgery. Fifty-six (50.9%) patients got pregnant and had at least one live birth. A total of 83 children were born. A significant difference in the successful pregnancy rate was found in patients diagnosed ≤ 35 years vs. > 35 years old (55.6% vs. 9.1%, respectively; p = 0.003). Surgical approach (laparoscopy vs. laparotomy) did not influence the chance of childbirth. Pre-term delivery constituted 6.25% of all births.Conclusions: Fertility-sparing surgery should be proposed to young women wishing to preserve fertility. The rate of spontaneous pregnancy is approximately 50%.The risk of relapse is significant but always of borderline histology and may be successfully treated by the second surgery. [ABSTRACT FROM AUTHOR]

Background : The regenerative efficacy of platelet-derived products has been recently investigated in the treatment of pelvic floor disorders (PFDs). We aimed to synthesize the current evidence of platelet-rich plasma (PRP) products used in urogynaecological disorders including vaginal atrophy, pelvic organ prolapse (POP), urinary incontinence, vaginal fistulas and vaginal mesh exposure. Methods : A meticulous search of the currently available literature on the use of PRP for the management of PFDs was performed using 3 electronic databases. Results : PRP could be a feasible alternative modality for the management of vaginal atrophy with favourable outcomes in vaginal atrophy parameters and patients' satisfaction, especially when hormone therapy is contraindicated. In patients with POP, an increase in collagen concentration after PRP application was observed while the use of PRP resulted in improvement of stress urinary incontinence symptoms. A considerable proportion of vesicovaginal fistulas were treated after application of PRP-based injections. Conclusions : There is only limited evidence of the use of PRP for PFDs. Platelet-rich plasma appears to be a promising, easy to apply, cost-effective and feasible alternative therapeutic modality for the management of various urogynaecological disorders. Future randomized trials are needed to confirm the efficacy of PRP in the treatment of urogynaecological disorders. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula (OF) is a significant cause of maternal morbidity in lower resource settings where women experience obstructed labor without timely access to skilled obstetric care. The true prevalence of OF is unknown; however, it is estimated to affect 2 to 3.5 million women globally. The Demographic and Health Surveys' (DHS) Fistula Module includes the OF symptom questions most frequently used for prevalence estimates, but these questions have not been validated. The aim of this study is to validate a symptom-based screening questionnaire for OF, including a question in the DHS' Fistula Module. Methods: With an international panel of fistula surgeons, we developed and face-validated a screening questionnaire that assessed for symptoms of lower urinary tract fistula (LUTF) and lower gastrointestinal tract fistula (LGTF), as well as urinary and fecal incontinence (UI, FI). We evaluated the discriminative ability of the questionnaire using a case–control study design in a 1:2:2 ratio: cases were parous women with fistula confirmed on examination, controls included parous women without fistula on examination, with and without UI symptoms. All women underwent screening for fistula symptoms and a physical examination, with examiners blinded to screening results. Results: Of the 367 Rwandan women who completed the questionnaires and underwent clinical examination, 59 women had LUTFs and 34 had LGTFs, 274 women were classified as controls with and without symptoms of UI. All LUTF screening questions performed well, including the DHS fistula question. The combination of two LUTF screening questions had the highest sensitivity (100%; 95% CI 94%, 100%), specificity (96%; 95% CI 93%, 98%), and area under the curve (AUC) (0.98). The combination of a LGTF screening question and FI question demonstrated the highest sensitivity (97%; 95% CI 85%, 100%), specificity (98%; 95% CI 95%, 99%) and AUC (0.98). Conclusions: Our OF screening questionnaire, including the DHS fistula question, demonstrated high sensitivities, specificities, and AUC. Plain language summary: Obstetric fistula (OF) is a birth injury which may occur in women living in lower resource settings who experience obstructed labor (not progressing normally) without access to skilled obstetric care. This injury causes a woman to constantly leak urine and/or feces from her birth canal. As OF affects poor women who live far from healthcare it is difficult to fully understand how many women worldwide have an OF. Furthermore, although some Demographic and Health Surveys (DHS) include OF symptom questions, the accuracy of these questions in identifying women with OF has not been studied. To more accurately determine which women may have an OF, we developed an OF screening questionnaire after consulting OF experts worldwide, which included a DHS OF question. We asked women from Rwanda this questionnaire and then examined these women to see if they have OF. Through this process we identified 59 women with a LUTF, 34 with a LGTF, and 274 without an OF. The best performing questions were able to identify women with LUTF 100% of the time and women with LGTF 97% of the time. We also showed that one DHS question detects women with LUTF and LGTF 100% and 85% of the time, respectively. Public health officials can now use the questions we studied to more accurately estimate how many women worldwide have OF, and best direct resources and skilled health care workers to the areas with the greatest need. [ABSTRACT FROM AUTHOR]

Introduction: India is in obstetric transition phase where there is high fertility along with high maternal mortality. To achieve sustainable developmental goals maternal death and maternal near miss data can be valuable in planning priorities and strategies. This study aims at providing some representative data from Punjab. Aims and objectives: To measure the maternal health indicators and the local trends in the important causes leading to severe maternal outcome i.e. maternal death(MD) and maternal near miss cases(MNM), and the differences, if any in these two severe maternal outcome(SMO) cohorts Material and methods: This observational study was conducted in one of the obstetric units of Government Medical College, Amritsar from March, 2015 to July, 2016 which included all pregnant women coming with/developing life threatening complications whose hospitalization course was followed for interventions done, pregnancy outcome and whether or not there was a SMO according to WHO criteria. Statistical analysis: Data collected was analysed statistically using MedCalc® statistical software online. Results: About 15% of our study population had a life threatening condition (WPLTC=413) and 2.8% of them suffered an SMO(81). SMO ratio in our delivered patients was 21.86 per 1000 live births, MMR of 655.97 per 100,000 live births and MNM ratio of 15.3/1000 live births. MNM mortality ratio was 3.13:1 andMI was 34.56%. WPLTC included only 12.38% of total deliveries but accounted for 46.2% of stillbirths. Amongst the WPLTC group also, those who suffered an SMO had a higher chance of stillbirth delivery (OR 1.63) as well as perinatal mortality (OR 1.68). Severe anaemia, placenta previa and multiple pregnancy were risk factors amongst WPLTC that were associated with increased probability of SMO. 73 % of SMOs were due to direct obstetric causes of which obstetric haemorrhage(29.6%) and hypertensive disorders of pregnancy(25.9%) were the most common. 27% of SMOs were due to indirect causes of which severe anemia was the most prevalent (20.99%) followed by liver diseases(12.34%) and cardiac diseases. Conclusion: 73 % of SMOs were due to direct obstetric causes and 27% were due to indirect causes. Most common underlying pathological condition in NM cases was obstetric hemorrhage followed by indirect causes whereas in MD cases, hypertensive disorders were the most common causes followed by obstetric hemorrhage and indirect causes. The programmatic interventions should focus on enhancing the critical obstetrics infrastructure and human resources. Primary public health services should aim to prevent anaemia and infections. [ABSTRACT FROM AUTHOR]

Complex vesicovaginal fistulas present a unique challenge to surgeons, and surgical reconstruction outcomes may be suboptimal. The aim is to evaluate the patient's characteristics as well as the factors influencing the functional outcome of complex vesicovaginal fistula surgical reconstruction. From 2016 to 2020, the medical records of 28 patients with complex fistulas were analyzed retrospectively. Means, ranges, and standard deviations were used in descriptive analysis. For categorical data, the Fisher exact probability test was used. The mean (standard deviation) age at presentation was 44.4 (10.04) years, while 85.7% (24) of patients were below 50 years of age. Hysterectomy was the most common aetiology in 21 (75%) patients, followed by radiotherapy in 3 (10.7%). Surgical repair success was seen in 24 (85.7%) patients. Four (14.2%) patients had an unsuccessful repair, one vaginal and three abdominal approach. All the failed abdominal repairs were radiation-induced fistula (p=0.001). Other factors that significantly influenced repair failure include vaginal mucosal atrophy (3 failures out of 8 patients, p=0.013), severe fibrosis around the fistula (4 failures out of 12 patients, p=0.024), non-placement of suprapubic catheter (2 failures out of 3 patients, p=0.006), and non-placement of interposition tissue flap (p=0.005). Hysterectomy and radiotherapy are the common causes of complex vesicovaginal fistula. The outcome of the repair is hampered by vaginal mucosal atrophy and severe scarring. The use of a suprapubic catheter and an interposition tissue flap improves the outcome. Post-irradiation fistula has a significant impact on repair outcome and necessitates special consideration for a comprehensive management strategy. [ABSTRACT FROM AUTHOR]

Retrospective survey was conducted for last three years of equine cases recorded at Veterinary Clinical Complex, Anand Agricultural University, Anand, Gujarat (India) from January 2016 to December 2018. Total 589 cases with various affections of surgical, gynecological, and medicinal were recorded, which included affections of musculoskeletal system (29.03%), colic (19.52%), wound (16.63%), eye (10.52%), fracture (4.41%), genital system (3.73%), neoplasm (3.39%), sinus, fistula and abscess (2.20%), urinary system (2.03%), digestive system (1.69%), hernia (0.33%) and others (6.45%). Out of different surgical affections musculoskeletal system affections (29.03%) were highest and amongst them 49.65% affection were in ceremonial horses (Dancing), whereas 44.75% affections were recorded during training period. Age wise incidence was found highest in 0 to 5 years age group (64.51%), followed by 6 to 10 years (24.27%) and above 10 years (11.20%) age groups. Seasonal incidence was highest in summer (39.04%), followed by winter (32.59%) and lowest in monsoon (28.35%). Sex wise higher incidences were found in males (58.91%) than in females (41.08%), while breed wise incidences were higher in non-descript breed (52.63%) followed by Kathiawadi (16.63%), Marwadi (15.61%), Kutchhi-Sindhi (14.43%), Thoroughbred (0.33%) and Crossbreds (0.33%). These findings reflected the needs for preventive and curative measures to be adopted in precious equines to reduce losses in equine industry. [ABSTRACT FROM AUTHOR]

To determine the factors influencing the outcomes of patients with recurrences post-hysterectomy for cervical cancers treated with external beam radiotherapy (EBRT) and interstitial brachytherapy. This prospective study accrued 90 patients between October 2008 and May 2014. All patients had had a prior hysterectomy and were diagnosed with recurrent vaginal apex cancers with squamous cell carcinomas. All underwent EBRT of 50 Gy (2 Gy/fraction) using tomotherapy-based image-guided intensity-modulated radiotherapy with concurrent chemotherapy of weekly cisplatin (40 mg/m2) followed by high dose rate interstitial brachytherapy boost of 20 Gy (4 Gy/fraction twice a day). Local relapse, disease-free and overall survival were determined. At a median follow-up of 74 months (4–123 months), 10/90 (11%) patients had local failure as the first site of relapse and 12/90 (13.3%) had first distant relapse. Only one patient had synchronous local and distant relapse. The 7-year local relapse-free, disease-free and overall survival were 87.6, 68.3 and 68.3%, respectively. Grade 2 and 3 rectal toxicity were seen in 5.6 and 3.1% of patients, respectively. Among these, two (2.2%) patients underwent temporary diversion colostomy due to vaginal sigmoid and rectovaginal fistula. Grade 2 and 3 bladder toxicity were seen in 5.6 and 1.1% of patients, respectively. In summary, the lateral disease extent (P = 0.048) and the presence of nodal disease at diagnosis (P = 0.08) had a statistically significant or borderline impact on local relapse without any impact on disease-free survival. Tumour size in itself did not affect overall survival. With the integration of EBRT and interstitial brachytherapy, most vaginal apex recurrences can be salvaged. An excellent local control and survival is achievable using intensity-modulated radiotherapy with image guidance and concurrent chemotherapy followed by high dose rate interstitial brachytherapy. • We studied outcomes in patients with vaginal recurrences after surgery. • The study used IG-IMRT to reduce dose to organs at risk and escalate nodal dose. • Interstitial brachytherapy using perineal template to a dose of 20 Gy/5 fractions. • 7-year local relapse-free, disease-free and overall survival were 87.6, 68 and 68%, respectively. • Grade 3 rectal and bladder toxicity were seen in 3.1 and 1.1% of patients, respectively. [ABSTRACT FROM AUTHOR]

Background Pediatric perianal fistula is a common disorder. It is more difficult to detect the fistula tract and internal opening (IO) in children than in adults. This study aimed to evaluate the clinical diagnostic value of transcutaneous perianal ultrasound for children with perianal fistula. Methods A retrospective review was conducted by analysing the preoperative transcutaneous perianal ultrasound and intraoperative exploration results of 203 consecutive patients who were <3 years old and diagnosed with perianal fistula. Analyses were conducted to evaluate the accuracy and consistency of utilizing the transcutaneous perianal ultrasound in the diagnosis of the complexity and location of the IO of perianal fistulas. Results Compared with intraoperative exploration, the preoperative transcutaneous perianal ultrasonography has almost perfect agreement (Kappa = 0.881, P  <   0.001) in the diagnosis of fistula tract complexity and IO with a sensitivity of 92% and a specificity of 97%. In addition, both intraoperative exploration and transcutaneous perianal ultrasound diagnosis showed high consistency in the identification of the IO of perianal fistulas (Quadrant I Kappa = 0.831, Quadrant II Kappa = 0.773, Quadrant III Kappa = 0.735, Quadrant IV Kappa = 0.802, all P  <   0.01). The IOs were mainly distributed in Quadrants IV and II in both simple and complex fistulas. Conclusions Transcutaneous perianal ultrasound, as a non-invasive and simple imaging technique, showed high accuracy in the diagnosis and identification of the fistula classification and IO location. It could be considered a first-line diagnostic instrument for evaluating perianal fistulas among children. [ABSTRACT FROM AUTHOR]

Aims: To report on the follow‐up of obstetric fistula repair using vascularized surgical flaps, namely the Singapore fasciocutaneous flap, the gracilis muscle flap, or a combination of both. Methods: This cross‐sectional study reports on the follow‐up of 60 patients after fistula repair with a vascularized surgical flap at the Fistula Care Center in Lilongwe, Malawi. The primary outcome was fistula closure based on patients' self‐reported continence grade. Secondary outcomes were urinary incontinence based on a 1‐h pad‐weight test, quality of life based on the Incontinence Quality of Life (I‐QOL) questionnaire, surgical complications, and the indication for additional surgery after repair. Results: Successful closure was achieved in 62% of cases and full continence was achieved in 12% of cases. Incontinence based on a 1‐h pad weight test improved between surgery and follow‐up. QOL scores based on the I‐QOL were low but patients indicated moderate to great improvement in quality of life. Twenty‐two (37%) patients experienced surgical complication, mostly minor wound breakdowns. No major complications were reported. Six (10%) patients were indicated for additional surgery during follow‐up. Conclusion: The relative safety of the surgical procedures is shown in the findings of this study, including no reports on major complications during follow‐up. Vascularized flaps should be considered in complex fistula cases, especially in repeat cases and before considering urinary diversion as a last resort. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) is a problem faced by many elderly women, and the incidence is increasing year by year. The pessary treatment is not only a conservative treatment method but also a first-line treatment method for this disease. However, if it is used improperly, multiple complications may occur during the treatment process, severe cases have to receive surgical intervention, and some may even be life-threatening. At present, there is a lack of unified guidelines for the treatment of pessaries in the world. Non-standard treatment operations and poor patient compliance are closely related to the occurrence of complications. This article focuses on summarizing and categorizing the currently reported pessary -related complications, introduces a grading method for pessary-related complications, and proposes a few ways to the prevention of complications as following. [ABSTRACT FROM AUTHOR]

Abstract Background Pelvic exenteration (PE) may be associated with prolonged overall survival (OS) in selected patients with advanced or recurrent cervical cancer. However, the factors related to improved survival following PE are not clearly defined. The aim of this study was to perform a retrospective analysis of OS rates in a group of patients undergoing PE in order to identify the factors related to improved long-term outcomes. Methods Our study group consisted of 44 patients, including 21 squamous cell cancer (SCC) patients, 22 patients with adenocarcinomas (AC) of the cervix, and one patient with undifferentiated cervical carcinoma. The patients were categorized according to the type of surgery, namely, primary surgery (12 patients) or surgery due to cancer recurrence (32 patients). Results In the group of patients with recurrent cervical cancer, we found that improved OS correlated with the SCC histological type and the presence of vaginal fistula. The need for reoperation within 30 days and the presence of severe adverse events significantly worsened the prognosis. We found a non significant trend toward improved survival in those patients with tumor-free margins. Lymph node metastases, the initial stage of the disease, the time to recurrence, and a history of hysterectomy had no impact on patients’ OS. In the group of patients undergoing primary PE, we observed a trend toward improved survival among those diagnosed with vaginal fistula. Conclusions Pelvic exenteration seemed to improve the long-term outcomes for patients with SCC cancer recurrence and vaginal fistula whose surgery was unrelated to severe adverse events.

Introduction: Peristomal skin excoriation is the most common complication of any stoma, especially of ileostomy and entero-cutaneous fistula. Effluent is erosive to skin and at times leads to excoriation of skin and pain or discomfort to the patient. Many strategies or local medications are being used to treat excoriated skin and give comfort to the patient. Aluminium paint is a cheap and effective means of managing skin excoriation. Materials and Methods: This case-control study was conducted in NEIGRIHMS from January 2015 to October 2020 on the role of aluminium paint for the management of skin excoriations due to stoma and fistula. A total of 19 patients were managed with aluminium paint and compared with the data of 19 other patients who were managed by conventional dressings as controls. Results: Aluminium paint helped in the earlier healing of skin excoriations and give comfort to the patients as compared to normal dressings. Conclusion: Aluminium paint is safe and cost-effective skin barrier to prevent and to manage skin excoriations. [ABSTRACT FROM AUTHOR]

Obstructed labour by large urinary bladder stones is one of the rare complications. Very small number of cases have been described in available literature. The diagnosis is generally based on the history of patient, their clinical evaluation and ultrasonography scans during pregnancy. Majority of antenatal cases in rural areas come first time in Primary Healthcare Centre (PHC) with labour pain and usually without any previous ultrasound scans. These cases are referred to higher centres due to prolonged obstructed labour. Although rare, but one should consider a large urinary bladder calculus as a cause of obstructed labour as early diagnosis and timely management of urinary bladder stones can prevent various complications like mechanical dystocia and Vesico-vaginal Fistula (VVF). Here authors report three cases of a large urinary bladder calculus causing obstructed labour. Caesarean section was done for obstructed labour and cystolithotomy was performed simultaneously in all three cases. [ABSTRACT FROM AUTHOR]

Objective: To determine outcomes and complications of vesico-vaginal fistula repair via vaginal and abdominal route. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation, Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: January 2020 to December 2020. Material & Methods: Patients having vesicovaginal fistula irrespective of age and fulfilling our inclusion criteria were included in the study using non-probability consecutive sampling technique. Patients having very large fistula, fistula involving neck of urinary bladder, failure of previous operation, patients with malignancy or co-morbidities were excluded from the study. Vaginal and abdominal approaches were used for fistula repair depending upon the level of fistula. Those operated via vaginal route were kept in trans-vaginal group and those operated via abdominal route were assigned trans-abdominal group. Results: Total 35 cases were studied having age 16-45 years with mean age of 32.6 ± 4.2 years. Transvaginal fistula repair was done in 37.1% and transabdominal repair was done in 62.8% cases. Most common cause of VVF was previous gynecological surgery in 77% cases. Success rate was 100% in transvaginal fistula repair as compared to 95.4% success rate achieved in transabdominal repair of fistula. Conclusion: Trans abdominal and transvaginal route both are good approaches but Transvaginal route of fistula repair is associated with high success rate than transabdominal route with minimum complications and better outcomes but it needs expert surgeon. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric anal sphincter injuries (OASI) are severe complications that can cause considerable short- and long-term morbidity. Austria, Canada, Norway, and Sweden have similar socio-economic characteristics, and all four countries have access to national birth registers. In this study, we hypothesized that the incidence of OASI should be very similar for different obstetric scenarios in these four countries. Therefore, the aim was to compare the incidence of OASI in these four countries in primiparous women, with spontaneous or instrumental delivery (vacuum or forceps), and in women with a first vaginal birth after cesarean section (VBAC).Material and Methods: Aggregated data on 1 933 930 vaginally delivered primiparous women and women with VBAC were retrieved from the birth registers gathered in Austria, Canada, Norway, and Sweden. The annual rate of OASI (ICD-10 codes O70.2-O70.3) was presented as the percentage of women with a spontaneous delivery, vacuum or forceps delivery, and a VBAC during the period 2004-2016.Results: The incidence of OASI varied considerably between countries and over time. Canada and Sweden had the highest rates, and Austria and Norway the lowest. In Norway, the rate of OASI decreased consistently for all types of deliveries after introducing a perineal protection program in 2004 (p < 0.001). During vacuum delivery, the incidence of OASI varied between countries from 4.1% to 15.5% across the study period. In Canada and Norway, the rate of OASI after a forceps delivery was similar in 2004 at ~20% and with differing trajectories to 24.3% (β 0.49) and 6.2% (β -1.15) (trend, all p < 0.001) in 2016.Conclusions: This comparative register study suggests that there may be considerable potential for lowering the incidence of OASI. The perineal protection program implemented by Norway has been successful. Each country should critically, without prejudice, analyze their current clinical practices and rate of OASI and consider the best preventive strategy. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the published literature regarding pelvic organ prolapse, dehiscence or evisceration, vaginal fistula, and dyspareunia after radical cystectomy and to describe the management approaches used to treat these conditions.Methods: Ovid MEDLINE, Ovid EMBASE, and Web of Science were systematically searched from January 1, 2001 to January 25, 2021 using a combination of search terms for bladder cancer and radical cystectomy with terms for four categories of vaginal complications (prolapse, fistula, evisceration/dehiscence, and dyspareunia). A total of 229 publications were identified, the final review included 28 publications.Results: Neobladder vaginal fistula was evaluated in 17 publications, with an incidence rate of 3 - 6% at higher volume centers, often along the anterior vaginal wall at the location of the neobladder-urethral anastomosis. Sexual function was evaluated in 10 studies, 7 of which utilized validated instruments. Maintaining the anterior vaginal wall and the distal urethra appeared to be associated with improved sexual function. Pelvic organ prolapse was assessed in 5 studies, only 1 used a validated questionnaire and none included a validated objective measure of pelvic organ support.Conclusion: There is a need for more prospective studies, using standardized instruments and subjective outcome measures to better define the incidence of vaginal complications after radical cystectomy for bladder cancer, and to understand their impact on quality of life measures. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to determine the outcome of surgically treated vesico-vaginal fistulae (VVaFs) using a transvaginal approach with a Latzko technique. Methods: A retrospective chart study was conducted at the Department of Urology, Radboud University Medical Centre. Surgical approaches to repair VVaF, from 2014 to September 2020, were selected. Patients who underwent a transvaginal approach were included. The primary objective was fistula closure. Secondary objectives were predictive factors for the outcome of the surgical procedure, for example, patient characteristics, leakage on cystography 2 weeks postoperative, and surgery time. Results: Thirty-one patients had surgery for VVaF. Twenty-five procedures (81%) were performed transvaginally. Thirteen of these (52%) had successful transvaginal closure after the first attempt. Seven out of 12 had their second attempt at the time of analysis, of which 4 (57%) were successfully closed thereafter. After either 1 or 2 attempts with the transvaginal approach, 17 (68%) of the VVaFs were successfully closed, but 79% if patients who did not yet had a second attempt were taken into account with the current success extrapolated. Only few minor complications were observed. Conclusion: Transvaginal closure of VVaFs with a Latzko technique is successful in about 79% in either 1 or 2 attempts, with few minor complications. A second attempt in closing the fistula with a transvaginal approach is useful, and a previous transvaginal attempt is not a contraindication for a second transvaginal attempt in closing the VVaF surgically. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula occurs in all developing countries but it is confined to the "fistula belt" across the northern half of Sub-Saharan Africa from Mauritania to Eritrea and in the developing countries of the Middle East and Asia. Ending obstetric fistula is critical to achieving Sustainable Development by 2030. So creating awareness on obstetrics fistula among women in the reproductive age group have a crucial role in reducing morbidity, mortality, and social stigma. Objective: To assess awareness on obstetric fistula and its associated factors among reproductive-age women attending governmental hospitals in southwest Ethiopia, 2021. Methods: An Institutional based cross-sectional study design was conducted among 413 women. The sample size was estimated by using a single population proportion formula. The collected data were coded and entered into EPI-data version 3.1 then exported to SPSS version 24 for descriptive and inferential analysis. Adjusted odds ratio (AOR) along with 95% confidence level was estimated to assess the strength of the association and variables with a p-value < 0.05 were considered to declare the statistical significance in the multivariable analysis in this study. Results: In this study, a total of 400 clients have participated in the study. The mean ages of participants were 30.26 (SD ± 8.525) years old. Education of women who cannot read and write are 85% less likely to have good awareness than women who are above the secondary level of education [AOR = 0.162; 95% CI (0.081–0.364)]. While Women who have primary education level are 83% less likely to have good awareness than women who are above the secondary level of education [AOR = 0.170; 95% CI (0.085–0.446)]. In addition, This study shows women who have not heard about obstetric complications are 54% less likely to have awareness of obstetric fistula than those who heard about obstetric complications [AOR = 0.458; 95% CI (0.368–0.643)]. Conclusion: This study identifies that the educational level of women, history of pregnancy, distance to the nearby health institution, and awareness of obstetrics complications were the factors associated with awareness of reproductive age women on obstetrics fistula. Hence, increasing awareness on obstetric fistula plays a key role in averting this problem. Plain Language Summary: Globally, between 2 and 3 million women were affected by obstetric fistula. Moreover, obstetric fistula is common in developing nations, as around 60% of it was found in sub-Saharan the so-called fistula belt' and middle east Asia. This devastating condition adversely affects both the Physical and Mental health of the women. There is little research conducted concerning the health burdens of the obstetric fistula in southwest Ethiopia. Therefore, this article provides a better understanding of the level of awareness on obstetric fistula and barrier (factors) that hinders the early detection and treatment of obstetric fistula. In this study, a cross-sectional study design was employed and data were collected from 400 women of the reproductive age group who visited public hospitals in the Ilu Aba Bor Zone. Our study shows that educational status, has not heard about complications of obstetric fistula, being far distant from the health facility, and not being pregnant were found to be factors that hinder the early detection and management of obstetric fistula. In conclusion, the finding of this study reported a low magnitude of level of awareness on obstetric fistula as compared to other previous studies. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Obstetric fistula, despite improved obstetric care, remains a real threat to poor women in rural Ethiopia. This study aimed to identify the risk factors that predispose women to obstetric fistula in South-western Ethiopia. Methods: An unmatched case-control study design was employed in which 48 cases (women with obstetric fistula) and 188 controls (women without obstetric fistula) were included. Data were collected using a pre-tested structured questionnaire and organized using Epidata version 3.1. Univariate, bivariate, and multivariate analysis was conducted using SPSS version 20.0. Adjusted odds ratio, 95% confidence level, and p-values were used as the main measure of association. Results: The study revealed that age at pregnancy of < 18 years (AOR = 5, 95% CI = 2–13), residing in rural areas (AOR = 4, 95% CI 1.6–11), lack of antenatal care (AOR = 5, 95% CI 2–14), no history of modern contraception utilization (AOR = 5, 95% CI = 2–13), post-term pregnancy (AOR = 8, 95% CI 3–22), and duration of labor > 24 hours (AOR = 4, 95% CI 2–9) were associated with obstetric fistula. Conclusions: The majority of fistula survivors were teenagers who were living in rural areas. Mothers having no antenatal care, not using modern contraception, having a post-term pregnancy, and having prolonged labor were at increased risk of developing obstetric fistula. Thus, delaying the age of first pregnancy, improving access to basic obstetric care, and advocating the use of modern contraceptive methods are crucial for teenage women residing in rural areas. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: In Sub-Saharan Africa, obstetric fistulas are a health crisis of extensive proportions. Although risk factors for failure are described, little data exist regarding differences in risk factors for early and late recurrences. Methods: A retrospective cohort study was conducted to evaluate risk factors for fistula recurrence. Inclusion criteria included women who underwent repair of urogenital fistula at a Fistula Hospital in Uganda between 2013 and 2019. Our primary objective was to determine the incidence of both early and late failures and to identify and compare risk factors for each. Logistic regression was used to calculate crude odds ratios (ORs) and 95% confidence intervals (CIs) representing the association between each risk factor for early and late failures. Covariates significantly associated with early or late failure in univariate analyses were included in multivariate logistic regression models. Results: A total of 541 patients were included. The incidence of early failure was 10.9%. Risk factors for early failure included stillbirth (aOR = 3.71, 95% CI: 1.38–9.96), fistula larger than 3 cm, (aOR = 3.12 95% CI: 1.40–6.93), presence of foot drop (aOR = 4.74, 95% CI:1.88–11.97), and perioperative blood transfusion (aOR = 3.10, 95% CI: 1.11–8.66). Risk factors for late failures included stillbirth (aOR = 4.63, 95% CI:1.04–20.51), and previous fistula repairs (aOR = 3.13, 95% CI:1.30–7.56). Conclusion: Both early and late failures can occur and risk factors for each may be different. Identifying patients at risk for late failures is important for improved counseling and highlights the importance of developing risk-reducing strategies to improve patient outcomes after discharge. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to evaluate the endourologic management of post-cesarean section ureterovaginal fistula. Methods: Between February 2016 and March 2019, eight patients presented because of vaginal leakage after cesarean section. All presented within 15 days from their original operations. Three of the patients had a vague lower abdominal pain, and five had ipsilateral flank pain; all had vaginal leakage. Physical examination, ultrasonography, and IVP were done to confirm the diagnosis. Ureteroscopy was the first treatment attempt, using two or three guide wires to find the proximal part of the ureter and insert a JJ stent. Results: In six patients, we could insert guide wires, find the proximal part of the ureter, and finally insert a JJ stent. In two patients, we could not even pass a guide wire, so we changed the position, and ureteral reimplantation was done. The stents were removed after 6 weeks, and after 3 months an IVP was planned again that showed all fistulae had resolved with no evidence of ureteral stricture. Conclusion: In cases of ureterovaginal fistula after cesarean section, ultrasonography and IVP with lateral view x-ray films may confirm the diagnosis. The traditional treatment for ureterovaginal fistula is ureteral reimplantation, but endoscopic management may be a viable technique with less invasiveness and faster results and recovery. Thus, retrograde stenting can be accomplished in selected patients with ureterovaginal fistula after cesarean section and may eliminate the need for reimplantation of the ureter. [ABSTRACT FROM AUTHOR]

We discuss a variety of contemporary issues relating to obstetric fistula. These include definitions of these injuries, the etiologic mechanisms by which fistulas occur, the role of specialist fistula centers in diagnosis and management, the classification of fistulas, and the assessment of surgical outcomes. We also review the growing need for complex reconstructive surgical procedures, follow-up challenges, and the transition to a fistula-free world in which other pathologies (such as pelvic organ prolapse) will be of increasing importance. Finally, we discuss the need to develop responsive systems of maternal health care that treat women with competence, compassion, respect, and fairness. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula is an abnormal opening between the vagina and bladder or rectum. Women affected by obstetric fistula are often abandoned by their husbands, stigmatized by the community, physically debilitated and blamed for their conditions. These factors lead the victims to low self esteem, depression and prolonged emotional trauma. The physical, emotional and social suffering associated with continuous leakage of urine has a profound impact on women quality of life. The aim of this study was to assess quality of life and associated factors among obstetric fistula patients in Ethiopia, and it will have a significant role for further intervention.Objective: To assess quality of life and associated factors among obstetric fistula patients in Ethiopia, 2017.Methods: Institution based cross-sectional study design was conducted at fistula centers in Ethiopia. Systematic sampling technique was used to recruit a total of 289 women with obstetric fistula. The World Health Organization Quality of Life-Brief (WHOQOL-BREF) Version was used to assess quality of life. We computed simple and multiple linear regression analysis to assess factors associated with quality of life and P-value < 0.05 was declared statistically significant. Adjusted unstandardized β coefficient of multiple linear regressions was used to describe associated factors of quality of life.Result: Of 289 women studied, only 12.1% felt satisfied with their general state of health and quality of life. In the physical health domain, the mean quality of life score was 40.78 ± .78. In the psychological domain, the mean quality of life score was 39.96 ± .82. In the social and environmental domain, the mean quality of life score was 32.9 ± .95, 36.45 ± .8, respectively. Duration of incontinence (β =  - 3.8,95% CI(- 6.95, - .62), patients coming for surgical procedure (β =  - 4.4, 95% CI(- 7.64, - 1.2), poor social support(β =  - 6.14, 95%CI (- 8.8, - 3.4), co-morbid anxiety (β =  - 4, 95% CI (- 7,-1.1) and depression (β =  - 9.2, 95% CI (- 12, - 6.4) were negatively associated with physical domain of quality of life. Co-morbid anxiety (β =  - 11,95% CI (- 14.8, - 7.3), employment (β = 9.1,95% CI (.5, 17.6), number of children(β = 2.1,95%CI(.8, 3.4), and depression(β =  - 6.3,95%CI(- 9.7, - 2.9) were associated with a psychological domain. Duration of incontinence (β =  - 8.1, 95%CI(- 12.82, - 3.4), poor social support (β =  - 7.8(- 12, - 3.6), patients coming for surgical procedure (β =  - 12, 95%CI (- 17.4, - 6.4) and co-morbid anxiety (β =  - 9.2, 95% CI (- 13.8, 4.5) were negatively associated with social domain of quality of life. Number of children present (β = 2.4, 95%CI (.82, 3.6), and poor social support (β =  - 5.5, 95%CI (- 9.5, - 1.5) were significantly associated with an environmental domain of quality of life.Conclusion and Recommendation: Co-morbid depression and anxiety, poor social support, duration of urine incontinence, employment, number of children, and duration of hospital stay were factors significantly associated with domains of QOL. Treating co-morbid depression and anxiety, and social support are necessary to increase women's quality of life. In addition, it is better to have a plane of income generation victims, and awareness creation about early treatment of the problem for community by the concerned body to improve women quality of life. [ABSTRACT FROM AUTHOR]