tailieunhanh - Vesico-vaginal and Recto-vaginal Fistula

The tragedy of obstetric fistula is that it is entirely preventable, if only there was ready access t0 quality obstetric services in all countries. Most are caused by ischemic necrosis to the genital tract and adjacent organs through prolonged obstructed labor. | 21 Vesico-vaginal and Recto-vaginal Fistula Brian Hancock INTRODUCTION The tragedy of obstetric fistula is that it is entirely preventable if only there was ready access to quality obstetric services in all countries. Most are caused by ischemic necrosis to the genital tract and adjacent organs through prolonged obstructed labor. A significant number are also due to operative damage to the bladder or ureter at cesarean section emergency hysterectomy for ruptured uterus and elective hysterectomy. A further small number are caused through sexual violence mainly in war conflict situations. The reason it is so prevalent in Africa and other poor countries is that the majority of women live in poor rural areas with no access to skilled obstetric care and emergency cesarean section. Thus most cases occur far from any hospitals and even if women reach a hospital most have limited facilities. The few doctors may have only basic knowledge let alone skill to repair any fistulas. Fistula patients are usually the poorest of the poor and cannot reach a specialized service even if one is available and they return to their villages to live the life of an outcast. Nobody knows how many fistula patients there are who have been forgotten and are without hope. Estimates are up to 2 million in Africa alone. In Ethiopia it is estimated that there are 9000 new cases a year. In the past decade there has been serious worldwide concern about the scale of the problem both for the need of prevention and repair of the large backlog of cases. National governments are working with many international organizations to address the problem. These include the newly formed International Society of Obstetric Fistula Surgeons ISOFS the UNFPA End fistula program the Addis Ababa Fistula Hospital Engender Health Women and Health Alliance International WAHA the Worldwide Fistula Fund the Fistula Foundation USA Freedom from Fistula Foundation and a great many smaller initiatives and committed individuals see