Fistula In Patients Research Articles

Angio-architecture of complex cranial dural arteriovenous fistulas: A single centre retrospective review of treatment modalities and outcomes

IntroductionCranial dural arteriovenous fistulas (DAVFs) are rare vascular lesions that often harbour complex angio-architectural features. This subtype of DAVF may require multiple, multimodality, or hybrid treatments. In this paper we aim to identify specific angio-architectural features that are present in complex cranial DAVFs and we report our series with respect to treatment modalities and outcomes. MethodsTwenty-five cranial Borden type II and III cranial DAVFs were treated at our Institution from 2013 to 2017. We classified nine (36%) as complex based on specific angio-architectural features. Treatment strategies were based on fistula location, angiographic features and patient's presenting condition. Phone interviews were used to confirm outcome at 6 and 12 months. ResultsFour patients (45%) presented with acute hydrocephalus, and 3 (33%) with intracranial hemorrhage. Multiple and combined treatment sessions were needed for all complex DAVFs. Five patients required 2 endovascular procedures each. One patient had 2 surgeries. The first line of treatment was endovascular in 6 cases (67%) and surgery in 3 (33%). Two treatment-related (22%) complications occurred. Complete disconnection was achieved in 5 out of 9 patients (55%). Two patients with an incomplete disconnection refused further treatment and were well at last follow up, with a partially treated fistula and persistent CVR. The other 3 patients concluded treatment after the end of our data collection period. At 1 year, 7/9 patients had stable or improved clinical symptoms, and 8/9 patients had GOS of 4 or 5. ConclusionsComplex cranial DAVF often require a multidisciplinary approach and multiple treatment sessions should be expected. Specific angio-architectural features that increase DAVF complexity include multiple arterial feeders, especially transosseous or pial, reflux into multiple cortical veins, sinus occlusion/entrapment, venous aneurysms, segmental stenosis, medial or deep location, and association with the deep venous system.

Physical etiology of sexual dysfunction in obstetric fistula patients: A prospective study.

To understand how the physical etiology of sexual dysfunction among women with obstetric fistulas can inform repair. A prospective cohort study included women aged 18years or over presenting at the Fistula Care Center, Bwaila Maternity Hospital, Lilongwe, Malawi, with obstetric vesicovaginal fistula before and after repair. The study took place between January 1, 2018, and December 31, 2018, and involved physical examinations and interviews. The primary outcome was sexual function. 115 were interviewed before and after repair. 44 (40.0%) preoperatively and 14 (12.2%) postoperatively reported sexual dysfunction. 94 women (81.7%) had little or no interest in sexual activity before repair. 55 women (47.8%) had little or no interest in sexual activity after repair. Before surgery, 69 women (60.0%) were not sexually active in the 30days before coming to the Fistula Care Centre. After surgery, 32 women (27.8%) were not sexually active in the 30days before returning to the Fistula Care Centre. Of those who were not sexually active in the 30days before coming to the Fistula Care Centre (n=69), the majority cited their health as a reason before repair (n=45, 65.2%), while the most commonly cited reason after repair was an absent partner (n=23, 35%). Given the significant percentage of women with obstetric fistula reporting sexual dysfunction after repair, a more holistic perspective of health outcomes should be considered. Further investment should be made in screening tools and surgical techniques targeting sexual dysfunction.

The persistent challenges and strategies for effective rehabilitation among obstetric fistula patients at Kitovu Mission Hospital, Uganda: a qualitative study

Background: Obstetric fistula poses a great physical, psychosocial and economic burden to girls and women in low and middle-income countries. About 53% of the obstetric fistula patients may live with untreated fistula for more than a year, thus patients require rehabilitation as they await repair and after repair. Little qualitative research exists on rehabilitation particularly on the challenges and effective strategies that inspired this study.Methods: A cross-sectional qualitative research approach used in-depth interviews and key informant interviews to collect data from 10 obstetric fistula patients who had been registered by the Urogynecology Department, Kitovu Hospital within two years before the time of data collection status and 12 key informants who include hospital staffs engaged in the management of fistula and patients’ partners who were involved in caregiving. Data were analyzed thematically using ATLAS.ti 7.5.Results: The major constraints encountered during rehabilitation were limited resources for practice, inadequate counseling especially among immediate relatives, and inadequate capital for self-sustainability and limited employment opportunities. Key informants also mentioned the issue of limited resources, budget constraints, inadequate supervision and follow up of patients. Only one patient who had not had fistula repair had knowledge of rehabilitation. To address the challenges, the participants suggested the need for rehabilitation despite repair status. They required more knowledge about sustainable livelihood programs and cash grants.Conclusions: The patients identified socioeconomic, institutional and political challenges to their rehabilitation. They emphasized the need for improved political commitment, adequate budget, and resource allocation and regular support supervision to ensure their effective rehabilitation.

Association of socio-demographic and obstetric factors with obstetric fistula patients’ perceptions towards life fulfillment in Kitovu Hospital, Uganda

Background: To date, obstetric fistula is one of the major public health challenges among the poorest, young women and girls in rural communities in low and middle-income countries. There is scarce information on the association of socio-demographic and obstetric factors with the obstetric fistula patients’ perceptions towards life fulfillment which compelled this study.Methods: A cross-sectional survey using a semi-structured questionnaire was done among 390 obstetric fistula patients registered within the past two years to the time of data collection at Kitovu Hospital, Masaka, Uganda. Pearson’s Chi square correlation was used to determine the association of socio-demographic and obstetric factors with perceptions towards life fulfillment using SPSS 25.0.Results: A larger proportion of obstetric fistula patients 226 (57.9%) had negative perceptions while 164 (42.1%) had positive perceptions. Maternal age, repair status, outcome of repair, self-perceived level of incontinence, and number of living children were statistically associated with patients’ perceptions towards life fulfillment at a P-value less than 0.001, marital status, p value of 0.005, and overall duration lived with fistula, p value of 0.009. A greater number of patients with tertiary education, 5 (83.3%) had positive perception, however, the association was not significant with a p value of 0.059. Fistula type, region of residence, and number of repairs were not statistically significant.Conclusions: Thus, socio-demographic and obstetric factors influence patients’ perceptions towards life a great deal. Efforts should focus on fistula prevention and timely repair so as to minimize probable experiences likely to result in negative perception that would eventually impede life fulfillment.

Effect of the Information Providing Program Provided by Operating Room Nurses on Anxiety and Self-Efficacy of Arteriovenous Fistula and Angioplasty Patients

Effect of the Information Providing Program Provided by Operating Room Nurses on Anxiety and Self-Efficacy of Arteriovenous Fistula and Angioplasty Patients

Pediatric Surgery Rate of Constipation After Sagittal Anorectoplasty For Rectoperineal Fistula

Abstract Background Rectoperineal fistula is a congenital low anorectal malformation that is presented with constipation and straining at stool. There is argument as regarding name, diagnosis and surgical treatment. Objectives to estimate the incidence of postoperative constipation among patients with rectoperineal fistula treated with anorectoplasty using Krickenbeck classification for postoperative outcomes. Patients and Methods The study was conducted between January 2018 and August 2018. The study included patients with rectoperineal fistula who underwent sagittal anorectoplasty (SARP) in the last five years in two tertiary hospitals; Ain Shams University Children Hospital and Banha Specialized Children Hospital. We excluded patients who underwent operations other than SARP and patients having Currarino syndrome and sacral anomaly like hemisacrum and caudal regression. Krickenbeck classification was used for assessment of constipation before and after operation. A simple questionnaire was used for follow up assessment. Results The study included 30 patients (19 female and 11 male). Their age at time of repair ranged from 3m to 78 months with a median age of 7.5 months. Rate of constipation in patients with rectoperineal fistula after SARP was 39%, while improvement rate was 65%. 14 patients out of 23 having preoperative constipation (61%) were treated from constipation, and one patient (4%) got improved regarding constipation grade and frequency, while remaining 8 patients (35%) were still having the same degree of constipation. There were 7 children who had no constipation before and after repair. These results were statistically significant as measured using McNemar test. Postoperative soiling was recorded in 7 patients; all of them had pseudo-incontinence (ORSI). Conclusion Rectoperineal fistula patients can gain benefit from SARP not just cosmetically, but also functionally (65% of constipated patients got improved).

A case report about an acquired bronchoesophageal fistula patient with acute respiratory distress syndrome after pneumonectomy

A case report about an acquired bronchoesophageal fistula patient with acute respiratory distress syndrome after pneumonectomy

Clinical urologic and urodynamic outcomes in patients with anorectal malformation and absent vagina after vaginal replacement

Introduction and objectivesAnorectal malformations (ARMs) represent a complex spectrum of anorectal and genitourinary anomalies and a paucity of evidence is available on long-term urologic outcomes in all ARM subtypes. It was our subjective bias from being a referral center for ARM patients that the subtype of rectovestibular fistula and absent vagina had higher risk of renal and bladder abnormalities than typical rectovestibular fistula patients. Therefore, to confirm or refute our clinical suspicions, the purpose of this study was to review this specific cohort of ARM patients and describe both the clinical urological and urodynamic outcomes. MethodsA retrospective cohort study was performed for 120 patients who were treated for ARM and vaginal replacement at our institution between 1991 and 2017. Fifteen patients with rectovestibular fistula and absent vagina were included in our review. Demographic and clinical data were abstracted from their medical records, including urodynamic findings, need for clean intermittent catheterization (CIC), urinary continence, and renal function. ResultsVaginal replacement surgery was undertaken concomitantly with ARM repair in 10 of the 15 patients (67%). One patient was lost to follow up, and mean follow up postoperatively was 39 months. In all but one patient, rectum or colon was used as the substrate for vaginal replacement. Of the 15 patients, 13 had continence data available. A total of 10 patients (77%) were able to achieve social continence. Overall six patients used CIC to manage their bladder and 40% of continent patients used CIC. Urinary continence outcomes in patients who had partial vaginal replacement compared to those with total vaginal replacement did not reveal a clinically significant difference. Continence was achieved in 3/4 patients (75%) with a history of tethered cord compared to 7/9 patients (78%) without a history of tethered cord release. Urodynamics were performed postoperatively in 7 of the 157 patients (47%). Uninhibited detrusor contractions (UDCs) were present in 3 out of 7 patients, and a cystometric capacity greater than expected was noted in 4 patients. Additionally, 2 patients had end filling detrusor pressure greater than 40 cm H2O. GFR data were available for 13 of the 15 patients and (85%) were classified as chronic kidney disease (CKD) stage I or not having any significant loss of renal function. ConclusionsIn this cohort of rectovestibular fistula and absent vagina, 77% reported achieving urinary continence. However CIC was employed in 40% of the patients which is higher than prior published noncloaca female ARM patient population. Urodynamic abnormalities were noted when performed and led to change in bladder management. Renal function measured with GFR was normal in 85%. Patients with rectovestibular fistula and absent vagina benefit from urologic screening given higher rates of lower urinary tract dysfunction that can require CIC to protect the upper urinary tract and achieve urinary continence. Type of studyCase series. Level of evidenceLevel IV.

P374 Disease course and fate of Crohn’s perianal fistula patients following failure of initial biologic therapy: real-world lessons on the impact of refractory disease from a tertiary centre cohort

Abstract Background Current evidence demonstrates that anti-TNF therapies lead to clinical response rates >50% have been reported in the short-term. These remission rates decrease to about a third of patients who initially achieved remission, after three years. Options are limited in cases refractory to biologic therapy, and there is limited knowledge of disease course in these cases, in part due to limited disease states characterised for Crohn’s perianal fistula in the absence of cure. This study applies recently described disease states within the context of Crohn’s perianal fistula to determine the fate of patients refractory to initial biologic therapy and quantitatively evaluate the health resource impact of the loss of response to treatment in this cohort. Methods Retrospective review of records from patients undergoing anti-TNF treatment for Crohn’s perianal fistula at St Mark’s Hospital between January 2007–December 2016, identified those refractory to treatment. We applied disease states defined from a recent vignette study of the general public and CD patients in the UK, and also obtained data on length of time patients spent in each disease state and subsequent disease states they transitioned to and created a Markov model to assess transition probabilities. We also collected data on healthcare resource utilisation (MRI, hospital interactions, surgical/medical therapy) within each disease state. Results Eight fistula disease states (including proctectomy, defunctioning surgery, remission and symptomatic states) were retrospectively ascribed to all clinical records/visits where documentation was available. The majority of refractory patients were switched on to alternate anti-TNF therapy and most reside in a ‘mild chronic symptomatic fistula’ disease state with a minority of patients subsequently transitioning into a severe disease state or remission state. Successful proctectomy disease state accounted for the longest period of continuous length of time in any one disease state (mean 4.4 years). The overall remission rate (of any duration) for our study cohort of 78 patients was 46%; however, sustained (1year or more) remission rate was 27%. Some 19% patients underwent proctectomy. There was considerable healthcare resource utilisation amongst all disease states particularly with biologic therapy (most expensive healthcare resource). Conclusion Whereas most patients reside in a mild chronic state following failure of at least one biologic therapy, a fifth of patients refractory to treatment undergo proctectomy which, when successful, accounts for the longest continuous length of time patients spend in a single disease state. There remains considerable healthcare resource utilisation and better treatment options are needed in refractory patients.

OP12 The incidence and disease course of perianal Crohn’s disease: A Danish nationwide cohort study

Abstract Background Perianal Crohn’s disease (pCD) has a major negative impact on patients’ quality of life and is complex to treat. Despite its putative high frequency and burden for patients, only a few studies have investigated the incidence, disease course and associated cancer-risk in a population-based setting. The aim was to assess the incidence and course of pCD in adult patients with CD within a 19-year period. Specifically, describing changes in medical and surgical management as well as rates of cancer. Methods The cohort comprised all individuals >18 years diagnosed with CD in Denmark between 1 January 1997 and 31 December 2015. Patients were identified in the National Patient Registry. Chi-square test, Mann–Whitney–Wilcoxon test and multivariate Cox regression analysis were used. Results A total of 1,697/9,739 (17%) patients with CD were found to have pCD. Perianal fistulas were the most common manifestation accounting for 943 (56%) cases. The onset of pCD before CD diagnosis occurred in 32%. The overall incidence of pCD was 20/1,000 patient-years. The incidence of pCD remained stable over time. More patients with pCD were treated with immunomodulators (70%) and biologics (35%) than those without pCD (51%, p < 0.001 and 15%, p < 0.001, respectively). Defunctioning stoma was performed in 157/943 (17%) of perianal fistula patients. Stoma formation in relation to resection was performed in 112/943 (12%) of perianal fistula patients. Patients with pCD were found to have a significantly increased risk of undergoing major abdominal surgery compared with patients without pCD (hazard ratio: 1.52, 95% CI: 1.40 to 1.65, p < 0.001). The incidence rate ratios of anal and rectal cancer in pCD patients were 12.46 (95% CI: 5.07 to 30.59, p < 0.001) and 2.41 (95% CI: 1.31 to 4.42, p = 0.003) respectively, when compared with non-IBD matched controls. The incidence rate ratio of anal and rectal cancer in pCD patients was 2.36 (95% CI: 0.86 to 6.50, p = 0.09) and 1.35 (95% CI: 0.68 to 2.68, p = 0.38) respectively, when compared with CD patients without pCD. Conclusion In this nationwide study, 17% of the CD patients developed pCD. The continuing high incidence of pCD suggests a limited disease-modifying effect of biologics. Patients with pCD were at increased risk of undergoing major surgery compared with non-pCD patients. The risk of rectal or anal cancer was increased in patients with pCD compared with non-IBD matched controls. These findings encourage surveillance of rectal and anal cancer.

P077 Metabonomic profiling distinguishes Crohn’s perianal fistulas and idiopathic idiopathic (cryptoglandular) perianal fistulas: possible clues to underlying pathogenesis?

Abstract Background The reasons why fistulas originate have been explained in idiopathic cases, with the cryptoglandular theory being widely accepted; however, in Crohn ́s disease, it is thought to involve interplay between microbiological, immunological and genetic factors. It remains unclear why fistulas persist. Novel investigative tools in systems biology are improving our understanding of pathogenesis, and one such tool is metabonomic profiling, whereby spectrometry is used to assess metabolic responses of complex systems in health and disease. These changes are mapped using analytical and statistical techniques. To the best our knowledge, these methodologies have not been applied to aid understanding of the pathogenesis of Crohn’s perianal fistula persistence. Methods Fistula tissue biopsy was obtained from the fistula tract of 30 patients with idiopathic perianal fistula and 20 patients with Crohn ́s anal fistula. Two analytical platforms were attempted to achieve broad metabolome coverage. Univariate (student t-test) and multivariate statistical data analyses were performed. From the latter principle component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA), models were built to find metabolites that could predict tissue samples from patients with either Crohn’s or idiopathic anal fistula. Metabolite putative identification was conducted by matching accurate mass:charge ratio (m/z) measurements of detected chromatographic features to theoretical value from in-house databases and on-line databases and previous publications. Results Significant OPLS-DA predictive models (validated with CV-ANOVA p-value <0.05) differentiated metabolites from tissue samples from Crohn’s vs. idiopathic anal fistula patients using both metabonomic profiling platforms (HILIC/lipid profiling). A total of 22 differentiating metabolites were identified from the HILIC profiling and 19 from the lipid profiling analysis. Mapped pathway analysis was performed for metabolites identified using online database searches. Conclusion Forty-one differentiating metabolites were discovered belonging to various classes of lipids, amino acids and nucleotides. Pathways involved included amino acid metabolism, phospholipid metabolism and glycerolipid metabolism amongst others. Further work in larger numbers is required to validate these findings as well as cross correlation with microbiome work to understand the impact of host gut interactions in the pathophysiology of Crohn’s and idiopathic perianal fistulas.

Nursing Process of Enterocutaneous Fistula Patient with Severe Acute Malnutrition in Pediatric Surgical Ward

<p><strong>Objective: </strong>This case study aims to prove the effectiveness of nursing intervention, particularly management of nutrition, fluid and electrolyte, ostomy care, and risk for infection management, at managing enterocutaneous fistula patient with severe acute malnutrition in pediatric surgical ward.</p><p><strong>Methods: </strong>This case study was performed by giving nursing care of enterocutaneous fistula patient with severe acute malnutrition for about 13 days based on the patient’s length of stay.</p><p><strong>Results: </strong>The target for weight gain in malnourished children was ≥ 50 grams/kg/week. Within thirteen days, weight of the patient rose 450 grams from 4700 grams to 5150 grams. Patient’s weight gain target was 470 grams in 14 days, this condition showed that increase in body weight was quite appropriate. Fistula output was decreased day by day and feces that came out from from anus has better solid consistency than before.</p><p><strong>Conclusion: </strong>Nutrition management aims to increase body weight during the preoperative period of the client. Hospital treatment managed to increase weight, the child did not experience vomiting and diarrhea from the first day of treatment, and appetite continued to increase every day. This is in accordance with the outcome criteria that has been established for the main problem of imbalanced nutrition: less than the body requirement. Furthermore, children are advised to get follow up care with regular weekly control obligations.</p><p> </p><p><strong>Keywords: </strong>child; enterocutaneous; fistula; malnutrition; nursing</p>

The clinical application of color Doppler ultrasound in guiding the puncture of new internal fistula in deep arteriovenous

Objective To investigate the clinical value of color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients. Methods Selected thirty patients with arteriovenous fistula not less than 5 mm deep in the Department of Hemodialysis Room of Wuhan First Hospital, and they were divided into observation group and control group by the method of random number generator in IBM SPSS Statistics 22.0 software, with 15 patients in each group. The control group was treated with conventional blind puncture by experienced nurses (849 times), while the observation group was treated with color Doppler ultrasound guided puncture (855 times). By comparing two groups of deep arteriovenous fistula in new fistula patients within 6 months of the one-time success rate of puncture, the incidence of adverse events such as subcutaneous hematoma, bleeding, pain, interruption or postponement of treatment, and accidental injury to arteries caused by puncture errors of internal fistula, and the patient′s satisfaction with the puncture and dialysis results was evaluated to observe the advantage of color Doppler ultrasound guidance in clinical application of deep arteriovenous new fistula puncture. Results The success rate of one-time puncture for internal fistula puncture in observation group was 98.95% (846/855), which was significantly higher than that in control group 81.27% (690/849), and the difference was statistically significant (χ2 = 149.753, P 0.05). The total incidence of adverse events caused by internal fistula puncture errors in the two groups was 1.99% (17/855) and 22.97% (195/849), respectively, and the difference was statistically significant (χ2=172.126, P < 0.01). The average rank of satisfaction in observation group was 1 261.25, which was higher than control group 440.86, and the difference was statistically significant (Z=-38.107, P < 0.01). Conclusions Color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients has important clinical application value. It can significantly improve the success rate of one-time new internal fistula puncture, reduce the occurrence of adverse events due to puncture failure, and reduce patient′s pain, which is worthy of clinical promotion. Key words: Doppler ultrasound; Arteriovenous fistula; Applied

An 8 Years experience in surgical treatment of anal fistula

Aim: To review our experience with patients who had been operated for perianal fistula based on cryptoglandular etiological basis and to reveal risk factors affecting postoperative results.Material and Methods: A total of 65 perianal fistula patients, who underwent surgical treatment, were screened for this retrospective study.Results: The mean age was 45.4 ± 10.6 years, with a predominance rate of male patients. The previous surgery rate for anal sepsis was 44.6%. The median (min-max) follow up time was 19 (15–103) weeks, and the duration of symptoms was 18 (6-250) weeks. The most common fistula type was intersphincteric (36.9%), and fistulotomy was the most preferred surgery (50.8%). New postoperative incontinence was found in 6 (8.2%) of patients, 5 (83.3%) of them had gas incontinence. The healing rate in the follow-up period was unsatisfactory for 12 (18.5%) patients. The significant risk factors for failure were BMI≥30 kg/m2 (p0.001), complex fistula with multiple fistula tracts (p=0.001), duration of symptoms ≥12wk (p=0.012), a history of previous surgery for anal sepsis (p=0.001), the presence of baseline incontinence (p=0.003), procedures except for fistulotomy (p=0.009).Conclusion: The risk factors most associated with failure were obesity (BMI≥30 kg/m2) and multiple fistula tracts. Other significant risk factors leading to failure were duration of symptoms ≥12wk, a history of previous surgery for anal sepsis, the presence of baseline incontinence, complex fistula type, and non-fistulotomy procedures. This study suggests the need for comparative, randomized controlled studies that investigate methods and their outcomes, particularly in complex fistulas.

The efficacy of continuous lumbar drainage in post-traumatic cerebrospinal fluid fistulas.

This study aims to investigate the clinical outcomes of patients who underwent closed continuous lumbar drainage (CLD) for post-traumatic cerebrospinal fluid (CSF) fistula and to compare with those of non-traumatic patients. The data of patients who were treated in the department of neurosurgery between January 2018 and December 2019 and underwent CLD were analyzed. The diagnosis, demographic characteristics, CSF results and clinical outcomes of these patients were evaluated. The outcomes of the patients with dura defect and CSF fistula due to trauma were compared with patients who underwent CLD for other diagnoses. In this study, 45 patients underwent CLD for 51 times. The mean age was 38.84 years, and 27 (60%) of the patients were male. Seven (15.55%) patients underwent CLD due to post-traumatic CSF fistula and 38 patients after tumor or malformation surgery. While five patients developed CSF fistula due to dura defect after gunshot injury, two patients developed CSF fistula secondary to motor vehicle accident. Staphylococcus Epidermidis was isolated in one patient among post-traumatic CSF fistula patients while Serratia Marcescens was isolated in patients with CSF fistula secondary to posterior fossa tumor surgery. While none of the seven patients died during the follow-up period in post-traumatic group, one of the 38 patients with CLD secondary to tumor surgery was lost due to sepsis in the follow-up period. CLD in post-traumatic CSF fistulas is a safe and effective treatment method. Especially in patients with gunshot wounds, CLD should be performed before revision surgery in the treatment of CSF fistula. Studies with different parameters are needed in larger trauma populations.

Obstetric Vesico-vaginal Fistulae: A Documentary Review of Women Managed in Mendefera Zonal Referral and National Fistula Hospital, Eritrea

Background: obstetric fistula is a devastating childbirth injury as a result of obstructed labor. It leads to chronic urinary incontinence and, in most cases, significant physical and emotional suffering. Its prevalence is high in Sab-Sahara African and South Asian countries. The objective of this study is to determine the incidence and describe the characteristics of women with obstetric Vesico-vaginal fistula. Methods: A retrospective cross-sectional study was conducted in all obstetric vesico-vaginal fistula patients. Patient identification performed through review of prerecorded logbook and patient card describing each patient admitted to fistula ward over a period of five years from January 1st 2014 to December 31, 2018. Medical records were reviewed to obtain data on socio-demographic and obstetric characteristics, clinical details, and treatment. Statistical analysis was performed using STATA-9. Results: There were 146 women with Vesico-vaginal fistula (VVF) admitted to the fistula hospital over the study period; of which 144 of them were obstetric fistula. During the study period the total number of health facility deliveries in Eritrea was 217,119 giving an estimated rate of obstetric VVF of 0.7/1000 facility deliveries. The median age, parity, and number of live births was 30, 3, and 2, respectively. One quarter (n=37) of the cases being in the age group of 20years or younger. The highest incidence of VVF (38%) was observed in Primiparous. 75% gave birth in a health facility, 54% of deliveries were by caesarean section, and 80% of babies were stillborn. 77% of repairs were successful. Conclusion: The incidence of fistula in Eritrea is relatively low as compared to other sub-Saharan African countries. In this study, age at fistula development was older than usually found, which might be due to poor access to emergency obstetric care (EmOC) that contributed more to this problem.

Rising trends in iatrogenic urogenital fistula: A new challenge.

ObjectiveTo analyze trends in iatrogenic urogenital fistula among patients admitted for fistula repair at the Pakistan Institute of Medical Sciences, Islamabad.MethodsIn this longitudinal study, all patients who presented for fistula repair between 2006 and 2018 were included in the study. Patient data were collected on age, parity, and type and etiology of fistula, which was classified as ischemic or iatrogenic.ResultsOf 634 fistula patients, 371 (58.5%) had iatrogenic fistula, while 263 (41.5%) patients developed ischemic fistula due to obstructed labor. Mean age of patients was 31.6 years. Yearly trends showed an increase in iatrogenic fistula from 43.2% in 2006–2008 to 71.4% in 2017–2018. The major etiological contributor to iatrogenic fistula was hysterectomy (52.5%), followed by cesarean hysterectomy (26.4%), and cesarean delivery (19.9%).ConclusionA rising trend in iatrogenic fistula was observed. This emphasizes the need for optimization of surgical approaches and surgical skills. Moreover, gynecologic surgeries should be restricted to authorized gynecologic surgeons.

Self-efficacy for Re-acceptance in Communities Among Obstetric Fistula Patients in Africa: A Systematic Review of Qualitative Data

The physical and psychosocial problems associated with obstetric fistula affect the patients’ efficacy to function within specific realms of life and affect their quality of life. This study documented the obstetric fistula patients’ self-efficacy for reacceptance in the communities in Africa. The study used keywords and the year of publication (2000 to 2019) as a search strategy to obtain data for review. A Critical Appraisal Skills Programme checklist specifically for qualitative studies was used. The search resulted in 284 studies: Google Scholar; 37, PubMed; 12, Hinari; 3, African Journals Online; 36, Psych-INFO; 1 and other websites; 195. Subsequently, 258 studies were excluded due to duplication and failure to meet the study objective leaving 26 studies, which were thematically analyzed. Studies report loss of hope, dignity, confidence, and self-esteem among obstetric fistula patients. They feel unfit, and are often anxious, attributes that impede their employability, mobility, connections, conjugal affairs, childbearing, and enthusiasm to accomplish various tasks; an index of low self-efficacy. However, when repaired and empowered through skills training and counseling, their self-efficacy improves. Self-efficacy is generally low among obstetric fistula patients especially those that have not yet had fistula repair. Alongside repair of the fistula, activities intended for societal reintegration reduce levels of anxiety, increase confidence and overall self-efficacy, which enables reacceptance.

Health-seeking behavior of obstetric fistula patients

Background: Obstetric fistula (OF) is one of the most dehumanizing diseases on the earth. It is a disease that reduces the female species of humans to a subhuman level where a woman continuously leaks urine and/or feces through her vagina. This birth complication is devastating to our women folks, particularly those living in the rural areas. Objectives: We aimed to look at the health-seeking behaviors of women who suffered from this condition with emphasis of identifying modifiable indices that could lead to reduction and/or eradication of the condition. Methodology: This was a descriptive, cross-sectional study where OF patient's health-seeking behavior was analyzed. All OF patients were recruited during the study period. Results: Fifty-two OF patients were interviewed during the study period. The mean age of the participants was 22.7 ± 7.6 years. Thirty-six participants (69.2%) had no formal education, and more than half of their husbands (57.7%) had no formal education. Majority (82.7%) of the participants were residing in the rural areas. More than half of the respondents (61.5%) had no source of income. Forty-seven (90.4%) attended antenatal care (ANC), and most of them (63.5%) had at least 4 ANC visits. Majority (76.9%) labored for more than 24 h and 35 (67.3%) had delay in reaching health facility. More than one-third (38.5%) were delivered through cesarean section. Forty-two respondents (80.8%) noticed urine leakage 2 days after delivery. Conclusion: Most of the findings here corroborated with the findings of earlier studies except for increased ANC attendance which might be due to increased awareness. The study clearly brought out the need to have deliveries conducted under skilled birth attendants to reduce/eradicate the menace of OF in our communities.

Vascular access creation in octogenarians: The effect of age on outcomes

BackgroundThe prevalence of end-stage renal disease is accelerating among older age groups. Patient-specific factors in the elderly patient group might advocate for a different vascular access creation approach, in which patency, risk of nonmaturation, and time to cannulation with accompanied prolonged catheter use should be of primary importance. The aim of this study was to determine which vascular access has the best outcomes and to determine whether age is associated with different outcomes after vascular access surgery. MethodsData were obtained from a prospectively maintained database of patients treated between November 2004 and December 2017. Two different patient groups were identified: the octogenarian group, consisting of patients aged ≥80 years; and the control group, consisting of all the other patients. A total of 694 vascular access procedures were included in this study, 65 in the octogenarian group and 629 in the control group. Primary, primary assisted, and secondary patency rates were calculated and compared between groups and vascular accesses. Multivariable analysis was used to determine whether age is an effect modifier in the association between type of vascular access and different patency outcomes. ResultsMean follow-up was 23.2 months in the octogenarian group and 21.2 months in the control group (P = .210). No significant differences were found in patient survival, with a 5-year survival rate of 63.8% (±5.9%) in the octogenarian group and 57.2% (±2.2%) in the control group (P = .866). Within the octogenarian group, primary failure rate was highest in the radiocephalic arteriovenous fistula (AVF) patients, 42.1% (P = .006). Brachiocephalic AVF had significantly improved assisted patency compared with the other vascular accesses among the octogenarians (P = .016). Age was not an effect modifier in the association between type of vascular access and different patency outcomes. The adjusted analysis, corrected for octogenarian age, diabetes mellitus, hypertension, and sex, showed that brachiocephalic AVF was significantly associated with an increase in primary patency (hazard ratio, 0.70; 95% confidence interval, 0.54-0.90; P = .006) and primary assisted patency (hazard ratio, 0.58; 95% confidence interval, 0.39-0.86; P = .006) compared with other vascular accesses. ConclusionsThe results of our study support primary placement of a brachiocephalic AVF in the octogenarian patient. A low primary failure rate was achieved with significant improved patency rates compared with the other vascular accesses.