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Complex obstetric fistulae--two case reports
1Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies.
The Ceylon Medical Journal
|October 29, 2000
Summary
Complex obstetric fistulae, including vesico-urethro-rectovaginal and vesico-cervico-vaginal types, were successfully repaired. Surgical techniques varied, with one patient achieving continence after multiple attempts, highlighting the challenges in managing these severe injuries.
Area of Science:
- Obstetrics and Gynecology
- Urology
- Surgical Repair
Background:
- Complex obstetric fistulae are severe injuries resulting from prolonged or obstructed labor.
- Mismanagement of labor can lead to devastating conditions like vesico-urethro-rectovaginal and vesico-cervico-vaginal fistulae.
Observation:
- Two cases of complex obstetric fistulae are presented.
- Case 1 involved a vesico-urethro-rectovaginal fistula in a young patient, requiring multiple surgical interventions.
- Case 2 involved a vesico-cervico-vaginal fistula successfully repaired via a transvaginal route.
Findings:
- A modified Martius graft was employed in Case 1.
- Ureteral transplantation was avoided due to the patient's young age.
- Seventeen repair attempts over ten years ultimately led to vesical and rectal continence in Case 1.
- Successful first-attempt transvaginal repair was achieved in Case 2.
Implications:
- Complex obstetric fistulae require tailored surgical approaches.
- Persistent and challenging cases may necessitate multiple interventions.
- Minimally invasive techniques, like transvaginal repair, can be highly effective.
- Successful repair restores quality of life and continence, crucial for patient well-being.