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Because this is a condition of shame and embarrassment, most women hide themselves and their condition and suffer in silence. In addition, after receiving initial treatment, health education is important to prevent fistulae in subsequent pregnancies. [16] Another challenge is the lack of trained professionals to provide surgery for fistula ...
In some types of fistulae, a seton may be tied with more tension and tightened periodically. In this case, the seton loop will slowly cut through tissue inside the loop while scarring behind the loop, essentially "pulling out" the fistula without surgery. This is the Kshar-Sutra method mentioned by Sushruta in ancient Indian surgical practice.
Rectovaginal fistulas are often the result of trauma during childbirth (in which case it is known as obstetric fistula), with increased risk associated with significant lacerations or interventions are used such as episiotomy or operative (forceps/vacuum extraction) deliveries [2] or in situations where there is inadequate health care, such as in some developing countries.
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A ureterovaginal fistula is a result of trauma, infection, pelvic surgery, radiation treatment and therapy, malignancy, or inflammatory bowel disease. Symptoms can be troubling for women especially since some clinicians delay treatment until inflammation is reduced and stronger tissue has formed. [2]
First- and second-degree tears rarely cause long-term problems. Among women who experience a third- or fourth-degree tear, 60–80% are asymptomatic after 12 months. [24] Faecal incontinence, faecal urgency, chronic perineal pain, pain with sex, and fistula formation occur in a minority of women, but may be permanent. [25]
The presence of a vaginal fistula has a profound effect on the quality of life since there is little control over the passage of urine and feces through the vagina. [6] [7] Urogenital fistulas are often classified according to their cause: obstetric fistula, congenital fistula and iatrogenic fistula. Urogenital fistulas can be classified by ...
Surgery can be carried out through the vagina, bladder or peritoneum and can be done via laparoscopic or robotic surgery. [8] Watchful waiting is the treatment of choice in case of small fistulas. The bladder is catheterised for a period of 4 to 8 weeks in order to allow spontaneous closure of the vesicouterine fistula.