Genitourinary Fistula Research Articles

Unusual Variations and Atypical Presentations of Diverticulitis

AbstractIn this article, we describe four unusual variations of diverticulitis: nonsigmoid colonic diverticulitis, giant colonic diverticulum, segmental colitis associated with diverticulosis, and small bowel diverticulitis. We discuss the epidemiology, presentation, and treatment of these types and how they differ from the presentation of typical sigmoid diverticulitis. We also review unusual presentations of typical sigmoid diverticulitis, including hematogenous liver abscess, necrotizing soft-tissue infection, and genitourinary fistula. Diverticulitis is a heterogeneous disease, and understanding the range of its presentations will facilitate early diagnosis and treatment.

Evaluation of Latrogenic Genitourinary Fistula after Major Gynaecological Operation in Patient Group Admitted in BSMMU

Introduction: Close proximity of urinary tract and genital systems in females poses potential risk of fistulas formation during surgical interventions. Gynaecological malignancy, bleeding, prolonged surgery, the presence of active infection during operation, endometriosis, large uterus, previous pelvic operation, pelvic adhesions and myoma uteri are major predisposing factors that may increase the risk of urological injuries & genitourinary fistulas. Genitourinary fistulas result in continuous or intermittent urinary incontinence and a significant public health issue with negative physical, emotional and social impacts on individuals. Materials and Methods: This cross sectional observational study was conducted in Department of Obstetrics &Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from 27th March 2017 to 26th September 2017. The sample was collected by purposive sampling technique. The study subjects were women with iatrogenic fistula (diagnosed after a clinical examination and investigations) attended in out-patients or in-patients department. Result: Mean age of patients was 32.5 ± 9.54 years. Vesicovaginal fistula was commonest cause for iatrogenic genitourinary fistula, present in 34 patients. Ureterovaginal fistula was 10 patients and 6 patients detected urethrovaginal. Aetiological factors revealed that, 46.0% occurred during vaginal hysterectomy, 18.0% due to abdominal hysterectomy, 20.0% due to laparotomy with salphingoophorectmy and 16.0% during laparotomy with cystectomy. Conclusion: The commonest urogenital fistula is the vesicovaginal fistula. Urinary leakage following gynaecological surgery is a dreaded complication due to the formation of urogenital fistula. Thorough evaluation, using all diagnostic tools for complete diagnosis, understanding the pathophysiology and choosing the best surgical procedure are mandatory to obtain good outcomes after the surgical procedures. Medicine Today 2024, Vol.36 (2): 110-113

Genitourinary Fistula: 5 Years' Experience of Five Referral Centers in Iran.

Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality.

Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute's perspective.

Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.

Genitourinary / Fecal Fistulae: Etiology, Types and Surgical Outcomes

Introduction: Genitourinary/ fecal fistula is an abnormal communication between the genital tract and either the urinary tract or the gastrointestinal tract. Among genitourinary fistulae, most common is the vesicovaginal followed by ureterovaginal fistula. Aims & Objectives: The aim of our study is to determine various causes and types of genitourinary/fecal fistulae and their surgical outcome in our setting. Place and Duration of Study: A descriptive, retrospective cross-sectional study was conducted at Central Park Teaching Hospital Hospital, Department of Obstetrics and Gynaecology from December 2013-December 2021. Material & Methods: Total of 77 patients presented with various types of genitourinary/fecal fistulae during the study period. All details as demographic characteristics, type and cause of fistula, route of repair and surgical outcome were taken on a standardized proforma. All data was entered and analyzed in SPSS version 26 for statistical analysis.p-value of less than 0.05 was regarded as significant. Results: In this study, the age range was from 22 to 62 years with mean age 38.38 + 10.67 years. Mean duration of fistula was computed as 45.47 + 71.31 months with the range of 1 month to 27 years (324 months). Average fistula size was 1.14 + 0.96 cm with the range of 0.25 cm to 3 centimeters. The obstetric causes of fistulae accounted 44% (n=34) while iatrogenic causes were seen in 56% (n=43) of patients. The most common type of fistula was VVF with 53 (69%) patients followed by uretero-vaginal fistula with 08 (10.0%). The least common type of fistula was urethro-vaginal with only 01 (1%) case of 22 years, 05 (7%) patients had RVF and 08 (10%) had vesico-uterine and vesico-cervical fistulae. the overall success rate is 88.3%. Conclusion: The iatrogenic causes of genitourinary/fecal fistulae are more prevalent than obstetric causes. The successful outcome of fistula repair depends on number of previous attempts of repair and outcome of repair worsen with each number of previous attempts.

Urological injuries following gynecologic surgery: clinical manifestations, diagnosis and management

Iatrogenic urinary tract injury constitutes a rare but serious complication of gynecologic surgery, occurring in 0.3% to 1.5% of all procedures. Delayed diagnosis and repair are associated with increased postoperative morbidity, mortality and a long-term negative impact on the quality of life. Intraoperative detection of urinary tract injuries allows for prompt repair, facilitates management and speeds up recovery. Bladder injuries are 3 times more common than ureteral injuries, and usually are recognized and repaired immediately with minimal complications. Undetected ureteral injuries lead to severe postoperative complications such as the formation of genitourinary fistulas, sepsis, renal loss and death. In this review we aim to describe the postoperative clinical manifestations, the diagnostic methods and therapeutic strategies for the management of urinary tract injuries, whether in the acute or delayed setting, in an effort to reduce the potential impact of subsequent complications to both patient and surgeon. Timely and effective repair of urinary tract injuries is critical to improve patient outcome, mitigate litigation risk, and allow an uneventful postoperative recovery in a careful manner.

Retrospective Study on Intra-cervical Fistula and the Preferable Routes of Repair

Genitourinary fistula has a devastating impact on women’s health. In the developing countries, the most common cause is obstetrical which may occur following obstructed labor or operative injury. The study was designed to analyze 13 rare cases of intra-cervical fistula and preferable routes of repair. The study period was from December 2013 up to November 2021 at four different hospitals in Bangladesh. A standard data collection sheet was used to record important pre, per and post-operative information. All 13 cases were multipara and were delivered by caesarean section. Approaches to repair the fistula were vaginally and abdomino-vaginally. All the 13 cases were primarily closed successfully. The conclusion is that although the vaginal route is preferred in most of the cases but the route of repair should be determined by accessibility of the fistula tract. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 24-27

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

Female genitourinary fistula (FGF) is an atypical connection between the female genitourinary system and the urinary tract. The abovementioned issue presents a dire public health concern and significantly affects the affected individuals’ quality of life. The classification of fistulae arising from the genitourinary tract encompasses a range of types, including vesicovaginal (VVF), rectovaginal (RVF), uterovesical (UVF), and urinary fistula, with the particular manifestation dependent upon the site of perforation.
 
 The development of consistent guidelines for FGF care poses a challenge due to the variability of clinical conditions. The selection of an appropriate treatment protocol is contingent upon the surgeon conducting the treatment and the resources at their disposal. In the medical field, it is advisable for surgeons to contemplate implementing conservative treatment methods, particularly in patients thoroughly assessed and deemed suitable for this approach.
 
 Delayed repair of FGF results in superior outcomes compared to early repair. The transvaginal repair approach is favored due to its advantageous features. Anticholinergic pharmacotherapeutics may be employed during the postoperative phase to enhance the therapeutic course of the bladder.
 
 Healthcare providers can refer their patients to a tertiary care facility with advanced resources and specialized expertise, provided the necessary facilities are available. Surgeons undergoing training and adapting to emerging trends are advised to enhance their proficiency in repairing vesicovaginal fistula (VVF).

Iatrogenic Fistula after Gynecological Operation in a Tertiary level Hospital

Background: Genitourinary fistula constitute a social calamity for the women in the developing countries.The most common cause being obstructed labor, as my study is on fistula due to iatrogenic cause, the most common cause is gynecological surgery. This study has been designed to find out the general information about iatrogenic genitourinary fistula and its outcome.
 Method: A cross-sectional descriptive study was done on 42 women suffering from urogenital fistula admitted in fistula corner in the department of Obs. & Gynae, Rajshahi Medical College Hospital from March to September 2015. A detailed history was taken to find out the casual factor. All the result had noted in pre-designed history sheet. The data has analyzed by SPSS version II and percentage were calculated.
 Results: Among 42 of total genitourinary fistula 19 cases of iatrogenic fistula were isolated after proper searching of detailed history. Among the 19 patients 11 (57.90%) patients developed fistula following total abdominal hysterectomy, 4 (21.05%) following laparotomy, 03 (15.79%) following vaginal hysterectomy with anterior colporrhaphy, and 1 (5.26%) patient developed fistula following repair of complete perineal tear. Among 11 patients with total abdominal hysterectomy, 06 were suffering from pelvic inflammatory diseases, 03 patients with fibroid uterus and of the rest 02 patients 01 with endometriosis and 01 patient with dysfunctional uterine bleeding. It was found in majority of the cases (68%) fistula developed within10 days. Among the iatrogenic genitourinary fistulas vesicovaginal type was found to be the most common (84.21%) in this study.
 Conclusion: The etiology of urogenital fistula is preventable. By utilizing basic principal of surgery, all types of urinary fistula can be repair.
 Central Medical College Journal Vol 6 No 1 January 2022 Page: 28-33

Eccentric cases of genitourinary fistula—Our ten years of experience

Eccentric cases of genitourinary fistula—Our ten years of experience

Recurrent vesico-cervical fistula: our experience.

Vesico-cervical (VCxF) is an uncommon entity among the gamut of genitourinary fistulas. The common causes include prolonged labor, previous lower-segment cesarean sections (LSCS), difficult vaginal deliveries, and traumatic injuries. A 31-year-old woman presented with a history of LSCS for prolonged labor 4 years ago followed by a failed robotic repair for diagnosed VCxF and vesico-uterine fistula (VUtF) 1 year ago. The patient developed a recurrence 4 weeks after catheter removal. The patient underwent cystoscopic fulguration 6 months after the robotic surgery, but this failed after 2 weeks. Now, the patient presented with continuous urine leakage through the vagina for 6 months. On evaluation, she was diagnosed with recurrent VCxF and a repeat transabdominal repair was planned. On cystovaginoscopy, there was difficulty in negotiating the fistulous tract from either end. With great difficulty, we placed the guidewire from the vaginal end, which reached a false paracervical passage. Although in the false tract, the guidewire helped with localization of the intraoperative fistula site. After docking, port placement, and localization of the fistula site (tug on the guide wire), a mini cystostomy was performed. A plane was created between the bladder and cervicovaginal layer and dissected up to 1 cm beyond the fistula. The cervicovaginal layer was closed. An omental tissue interposition was followed by cystotomy closure and drain placement. The postoperative period was uneventful, and the patient was discharged on the 2nd day after drain removal. The catheter was removed after 3 weeks and the patient is doing fine under regular follow-up for 6 months. It is challenging to diagnose and repair VCxF. Transabdominal repair is better than transvaginal repair owing to its location. Patients can opt for open or minimally invasive (laparoscopic/robotic) surgery, with better postoperative outcomes in minimally invasive techniques.

MP49-05 RECENT TRENDS AND CHARACTERISTICS OF GENITOURINARY FISTULAS IN RWANDA

You have accessJournal of UrologyCME1 Apr 2023MP49-05 RECENT TRENDS AND CHARACTERISTICS OF GENITOURINARY FISTULAS IN RWANDA Patricia Maymi-Castrodad, Angie Jang, Marcellus Johnson, Raj Purohit, Divine Ingabire, Margaret Catherine Fink, Fanique Simbi, Kigali Rwanda, Priyanka Gupta, and Stephanie Kielb Patricia Maymi-CastrodadPatricia Maymi-Castrodad More articles by this author , Angie JangAngie Jang More articles by this author , Marcellus JohnsonMarcellus Johnson More articles by this author , Raj PurohitRaj Purohit More articles by this author , Divine IngabireDivine Ingabire More articles by this author , Margaret Catherine FinkMargaret Catherine Fink More articles by this author , Fanique SimbiFanique Simbi More articles by this author , Kigali RwandaKigali Rwanda More articles by this author , Priyanka GuptaPriyanka Gupta More articles by this author , and Stephanie KielbStephanie Kielb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genitourinary fistulas (GU) in Rwanda have significantly increased in recent years. We previously reported an increase in the proportion of vesicouterine, vesicocervical and uterovaginal fistulas, with the majority occurring after Cesarean section. Our goal is to examine the characteristics of our the most recent cohort. METHODS: A cross-sectional study was conducted of women presenting for evaluation to the International Organization for Women and Development (IWOD) in Kigali, Rwanda, from 2018 to 2019, and 2022. No data was collected during years 2020 and 2021, due to the COVID-19 pandemic. Data was collected from medical records and included region of residence, surgical history, presence of fistula, and type. RESULTS: A total of 434 women were evaluated, of these 194 (44.7%) were diagnosed with GU fistula. In 2018, fistula types were 40 (52%) vesicovaginal, 5 (6%) urethral, 5 (6%) ureterovaginal, 23 (30%) vesicoureterine or vesicocervical, and 7 (9%) juxtacervical. In 2019, the fistula types were 26 (41%) vesicovaginal, 4 (6%) urethral, 6 (10%) ureterovaginal, 17 (27%) vesicoureterine or vesicocervical, and 10 (16%) juxtacervical. In 2022, the fistula types were 33 (61%) vesicovaginal, no urethral fistula reported, 7 (13%) ureterovaginal, 8 (15%) vesicoureterine or vesicocervical, and 6 (11%) juxtacervical. CONCLUSIONS: In comparison to our prior cohort, recent data shows a stable proportion of types of fistulas. The increased number of vesicouterine, vesicocervical, and juxtacervical fistula may be higher due to increased performance of Cesarean sections. Source of Funding: AUA Humanitarian Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e679 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patricia Maymi-Castrodad More articles by this author Angie Jang More articles by this author Marcellus Johnson More articles by this author Raj Purohit More articles by this author Divine Ingabire More articles by this author Margaret Catherine Fink More articles by this author Fanique Simbi More articles by this author Kigali Rwanda More articles by this author Priyanka Gupta More articles by this author Stephanie Kielb More articles by this author Expand All Advertisement PDF downloadLoading ...

Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology.

The use of robot-assisted technology has been widely adopted in urological oncological surgery and its benefits have been well established. In recent years, robotic technology has also been used in several functional reconstructive and neuro-urology (FRNU) procedures. The aim of this review was to evaluate the current evidence in the use of robotic technology in the field of FRNU. We performed a PubMed-based literature search between July and August 2022. The keywords we included were 'robotic assisted', 'ureteric reimplantation', 'cystoplasty', 'ileal conduit', 'neobladder', 'sacrocolpopexy', 'colposuspension', 'artificial urinary sphincter', 'genitourinary fistula' and 'posterior urethral stenoses'. We identified the latest available evidence in the use of robotic technology in specific FRNU procedures such as the reconstruction of the ureters, bladder and urinary sphincter, urinary diversion, and repair of genitourinary prolapse and fistula. We found that there is a lack of prospective studies to assess the robotic-assisted approach in the field of FRNU. Despite this, the advantages that robotic technology can bring to the field of FRNU are evident, including better ergonomics and visual field, less blood loss and shorter hospital stays. There is therefore a need for further prospective studies with larger patient numbers and longer follow-up periods to establish the reproducibility of these results and the long-term efficacy of the procedures, as well as the impact on patient outcomes. Common index procedures and a standardized approach to these procedures should be identified to enhance training.

Risk factors for and delayed recognition of genitourinary fistula following radical hysterectomy for cervical cancer: a population-based analysis.

This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test. In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.

The Trend of Iatrogenic Genitourinary Fistula from 2005 to 2019 and Its Risk Factors at Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia: A Retrospective Study

Background: Genitourinary fistula is one of a public health importance in low- and middle-income countries. It causes multiple health adversities. Mainly, lack of timely and appropriate intervention such as cesarean section causes genitourinary fistula. Nevertheless, iatrogenic genitourinary fistula is a result of medical error during obstetric and gynecological surgery such as while cesarean section and hysterectomy. This study examined the trend of iatrogenic genitourinary fistula, major surgical procedures leading to iatrogenic fistula and its risk factors. Methods: a facility based cross sectional study design was deployed. The respondents were included retrospectively using their medical history from January 2005 to December 2019 at Addis Ababa fistula hospital, Addis Ababa, Ethiopia. Data was analyzed using SPSS version 20.0 software. Annual percent change and average annual percent change were calculated using joinpoint regression analysis on joinpoint regression program version 4.8.0.1. Bivariate and multivariable regression model was also undertaken to implore the important risk factors for iatrogenic genitourinary fistula. Results: Total 9229 fistula patients treated in the hospital. Of which 643(6.96%) and 8,586(93.03%) referred iatrogenic genitourinary fistula and obstetric fistula cases, respectively. The mean age of iatrogenic genitourinary fistula patients was 30.02 (± 4.63 SD) years, ranged 17- 45 years. Among the iatrogenic genitourinary fistula cases, 341(53%) were caused by cesarean section. Other causes were errors while repairing ruptured uterus 131(20.4), during undertaking hysterectomy for ruptured uterus 78(12.1%), and while gynecological hysterectomy 93(14.5%). From 2005 to 2019, there was a significant rising trend in iatrogenic genitourinary fistula (1.55% to 52.9%, p&lt;0.001). Average annual percent change from 2005 to 2019 was 13.2% (95% CI: 7.7, 18.9).Statistically significant risk factors for iatrogenic genitourinary fistula were history of obstetric or gynecologic surgery, type of institution where the surgery conducted, and parity. Conclusion: The trend of IGF substantially increased while the OF declined over 2005 to 2019 period. Patient safety and quality surgical procedure on pelvic surgeries is paramount important. The study also revealed that CS was the most frequent surgery resulting IGF followed by repairing ruptured uterus, hysterectomy for ruptured uterus and gynecologic hysterectomy

Iatrogenic genito-urinary fistula following cesarean birth in nine sub-Saharan African countries: a retrospective review

BackgroundGenito-urinary fistulas may occur as complications of obstetric surgery. Location and circumstances can indicate iatrogenic origin as opposed to pressure necrosis following prolonged, obstructed labor.MethodsThis retrospective review focuses on 787 women with iatrogenic genito-urinary fistulas among 2942 women who developed fistulas after cesarean birth between 1994 and 2017. They are a subset of 5469 women who sought obstetric fistula repair between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. We compared genito-urinary fistula classifications following vaginal birth to classifications following cesarean birth. We assessed whether and how the proportion of iatrogenic genito-urinary fistula was changing over time among women with fistula, comparing women with iatrogenic fistulas to women with fistulas attributable to pressure necrosis. We used mixed effects logistic regression to model the rise in iatrogenic fistula among births resulting in fistula and specifically among cesarean births resulting in fistula.ResultsOver one-quarter of women with fistula following cesarean birth (26.8%, 787/2942) had an injury caused by surgery rather than pressure necrosis due to prolonged, obstructed labor. Controlling for age, parity, and previous abdominal surgery, the odds of iatrogenic origin nearly doubled over time among all births resulting in fistula (aOR 1.94; 95% CI 1.48–2.54) and rose by 37% among cesarean births resulting in fistula (aOR 1.37; 95% CI 1.02–1.83). In Kenya and Rwanda the rise of iatrogenic injury outpaced the increasing frequency of cesarean birth.ConclusionsDespite the strong association between obstetric fistula and prolonged, obstructed labor, more than a quarter of women with fistula after cesarean birth had injuries due to surgical complications rather than pressure necrosis. Risks of iatrogenic fistula during cesarean birth reinforce the importance of appropriate labor management and cesarean decision-making. Rising numbers of iatrogenic fistulas signal a quality crisis in emergency obstetric care. Unaddressed, the impact of this problem will grow as cesarean births become more common.

Genitourinary Fistula: A Summary of 18 Years’ Experience in Rajshahi Medical College Hospital, Rajshahi, Bangladesh

Background: Vesico-vaginal fistula is a chronic health condition when abnormal connection between bladder and vagina is seen and causes constant dribbling of urine through vagina. Uretero-vaginal fistula (UVF) defines an abnormal communication between the ureter and vagina which causes urinary incontinence, frequent infection, and discomfort. Methods: This observational longitudinal study was conducted in between 2005- April 2022, at the department of Obstetrics and Gynae in Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The total sample size for this study was 503. Result: Most of the patients 127(25.25%) were between the age of 26-35 years, 125(24.86%) were between the age of 36-45 years, 116(23.06%) were between the age of 46-55 years, 79(15.70%) patients were more than 55 years &amp; remaining 56(11.13%) were between the age of 15-25 years. Regarding the etiology of fistulas, most of the fistulas were following TAH 199(39.56%), 174(34.59%) following obstructed labor, 43(8.55%) following LUCS, 31(6.17%) following corrosive application, 19(3.78%) following malignancy, 18 (3.58%) following Trauma, 8(1.59%) following VH, and others 11(2.18%). Among 503 patients, 423 (84.09%) were Vesico vaginal fistula (VVF), 52 (10.35%) were Rectovaginal fistula (RVF), 21 (4.18%) were Ureterovaginal fistula (UVF), 4 (0.79%) were Vesico uterine fistula and 3 (0.59%) were Vesicocervical fistula. Out of 503 patients, operation was performed in 330 patients. Remaining 173 patients, 95(18.88%) were conservatively treated and 78(15.50%) were referred to higher centre. Repair of fistulas was done in vaginal route 244(74%) and abdominal route were 86(26%). Operation was successful 293(88.79%) and was failed in 37(11.21%). Conclusion: In the past, VVF, UVF and RVF were thought to be the incurable problem but with advanced surgical practice, availability of good suture material and antibiotics it can be cured surgically. There is increased incidence of post-surgical fistula and .......

Gastrointestinal/genitourinary perforation and fistula formation with or without bevacizumab in patients with previously irradiated recurrent cervical cancer: a Korean multicenter retrospective study of the Gynecologic Oncology Research Investigators Collaboration (GORILLA) group (GORILLA-1001)

BackgroundThis study aims to evaluate the incidence of and identify risk factors for gastrointestinal (GI) and genitourinary (GU) fistula or perforation formation with or without bevacizumab in patients with recurrent cervical cancer who underwent pelvic radiation therapy (RT).MethodsMedical records of patients with recurrent cervical cancer who previously underwent pelvic RT between 2007 and 2020 were retrospectively reviewed. Clinicopathological factors were compared between groups that are stratified according to: 1) fistula/perforation (+) versus (-); and 2) bevacizumab plus conventional chemotherapy (BC) versus chemotherapy alone (C). Univariate and multivariate regression analyses were performed to identify risk factors for fistula/perforation. Overall survival (OS) was compared between the different groups.ResultsOf 219 participants, fistula/perforation of any grade occurred in 36 patients (16.4%); 27 fistulas and 9 perforations. Bevacizumab was more frequently used in Bevacizumab was more frequently used ( +) group than fistula/perforation (-) group (p = 0.015). Multivariate analysis showed that bevacizumab administration was the only independent risk factor for fistula or perforation (HR, 3.27; 95% CI, 1.18–9.10; P = 0.023). F/P was observed more frequently in women receiving BC (n = 144) than those receiving C (n = 75) (20.8% vs. 8.0%; P = 0.019). During median follow-up of 33.7 months (1.2–185.6 months), no significant OS difference was observed between fistula/perforation ( +) vs. (-) (hazards ratio [HR], 1.78; median 84.2 months [95% CI, 59.3–109.0] vs. 129.5 months [95% CI, 114.1–144.9]; P = 0.065) or BC vs. C (HR, 1.03; median 119.8 months [95% CI, 97.3–142.3] vs. 115.7 months [95% CI, 96.0–135.4]; P = 0.928).ConclusionsThis study suggests that incorporation of bevacizumab in chemotherapy regimens for treating recurrent cervical cancer in patients who underwent pelvic RT incurs considerable risk for GI/GU fistula or perforation. There were no other independent risk factors for developing GI/GU fistula or perforation in this study population.

Platelet Rich Plasma in Gynecology-Discovering Undiscovered-Review.

Regenerative medicine combines elements of tissue engineering and molecular biology aiming to support the regeneration and repair processes of damaged tissues, cells and organs. The most commonly used preparation in regenerative medicine is platelet rich plasma (PRP) containing numerous growth factors present in platelet granularities. This therapy is increasingly used in various fields of medicine. This article is a review of literature on the use of PRP in gynecology and obstetrics. There is no doubt that the released growth factors and proteins have a beneficial effect on wound healing and regeneration processes. So far, its widest application is in reproductive medicine, especially in cases of thin endometrium, Asherman’s syndrome, or premature ovarian failure (POF) but also in wound healing and lower urinary tract symptoms (LUTS), such as urinary incontinence or recurrent genitourinary fistula auxiliary treatment. Further research is, however, needed to confirm the effectiveness and the possibility of its application in many other disorders.

Comparison between preoperative and postoperative depression scores among genitourinary fistula patients.

Objective: To compare depression scores in genitourinary fistula patients according to Glasgow depression scale pre and postoperatively in tertiary care hospital. Study Design: Prospective Cohort study. Setting: Inpatient and Outpatient Department of Gynecology and Obstetrics, Isra University Hospital Hyderabad. Period: December 2018 to December 2019. Material &amp; Methods: Patients with confirmed genitourinary fistulas undergoing corrective surgery were included. Glasgow Depression scale questionnaire was filled in Gynae ward at time of admission, postoperatively at discharge (14-21 days after surgery) and at 6 months follow-up after discharge in Urogynaecological Out Patient Department. In Glasgow depression scale 20 questions were asked from patients scoring 0,1 and 2 according to answers. Those scored greater than 13 were referred to primary mental health care center and Psychologist. Results: Total of 164 patients had successful genitourinary fistula repair. The average age of women was 47.63 (SD = ±17.1) years. Mean of depression scores preoperatively, at time of discharge and after 6 months of discharge was 19.69 (SD= ±2.61), 14.90 (SD= ±2.22) and 11.34 (SD= ±2.01) respectively. Mean decrease in depression score from preoperative to six months after discharge was 8.35 units, considered statistically significant with p-value less than 0.01. Conclusion: There is significant difference in depression scores preoperatively and postoperatively. Psychological symptoms decreases after surgical correction of fistulas.