Obstetric Fistula

Historical Introduction.- The Era Before James Marion Sims.- James Marion Sims (1813-1883) and the First Fistula Hospital.- The Post-Sims Era.- Fistula Surgeons in the Modern Era.- The Hamlins of Ethiopia and the Second Fistula Hospital.- The Incidence, Etiology and Pathology of Obstetric Fistula.- Incidence.- Etiology.- i) Spontaneous Development.- ii) Fistulae Due to Trauma.- iii) Social Factors.- iv) Traditional Genital Tract Injury and Mutilation.- v) The Influence of Bilharzia.- vi) Social Consequences of Genital Fistula.- Pathology of Obstetric Fistula.- i) Pressure Necrosis.- ii) Healing Phase.- iii) Associated Diseases and Conditions.- Management of Urinary Fistulae.- Clinical Features.- i) Classification.- ii) Symptoms.- iii) Diagnosis and Investigation.- Fistulae Involving the Urinary System-Clinical Groups.- Surgical Correction.- i) Prophylaxis.- ii) Difficulties Associated with Urinary Fistulae.- iii) Methods Available for Surgical Correction.- Cauterization.- VaginalSurgery.- Abdominal Surgery-the Transvesical Extraperioneal Approach.- Transvesical Intraperitoneal Approach.- Combined Abdomino-Vaginal Approach.- Colpocleisis.- Transplantation of Ureters.- Unorthodox Approaches.- iv) Choice of Surgical Approach.- Principles of Vaginal Closure.- 1. Immediate Preoperative Requirements.- 2. Adequate Exposure.- 3. Assessment Under Anesthesia.- 4. Mobilization.- 5. Excision of Scar Tissue.- 6. Care of the Ureters.- 7. Bladder Wall Closure.- 8. Grafting.- 9. Closing the Vaginal Skin.- 10. Vaginal Pack.- 11. Postoperative Management.- Complications.- Recto- Vaginal Fistula.- Etiology.- Clinical Features.- Surgical Correction.