Vesicovaginal fistula

from Wikipedia, the free encyclopedia
Classification according to ICD-10
N82.0 Vesicovaginal fistula
ICD-10 online (WHO version 2019)
Tissue at risk for pressure necrosis during childbirth (red)

The vesicovaginal fistula (also bladder-vaginal fistula ) is an abnormal connection ( fistula ) between the urinary bladder ( vesica urinaria ) and the vagina . The main symptom is the uncontrollable loss of urine ( urinary incontinence ).

Epidemiology

In industrialized countries, vesicovaginal fistulas are rare and usually the result of surgical complications; z. B. by injury to the bladder wall. The symptoms usually start about 5 to 10 days after an abdominal operation. In developing countries, especially in Central Africa, vesicovaginal and other abdominal fistulas are far more common. The common cause there is the prolonged, difficult birth, which can lead to pressure necrosis of the vaginal and urinary bladder walls . Risk factors are poor medical care and the young age of many women in labor. In West Africa, an incidence of 3–4 vesicovaginal fistulas / 1000 births is reported. Approximately 500,000 to 2 million women worldwide are believed to be living with previously untreated vesicovaginal fistulas. Even rape and genital mutilation can cause fistulas.

Physical impact

Vesicovaginal fistulas can lead to a number of different complications. These include amenorrhea , secondary infertility, vaginal stenoses due to scarring, tissue binding and subsequent vaginal contracture.

Diagnosis

Vesicovaginal fistulas can be discovered and localized by vaginal inspection. Imaging techniques such as cystography , cystoscopy , computed tomography, and magnetic resonance imaging can be useful for a more detailed description.

Socio-cultural consequences

In addition to the severe physical impairments, many of the women suffer from the socio-cultural consequences of fistula disease. The uncontrolled drainage of urine and possibly also feces creates a strong odor. Insufficient hygienic conditions also often contribute to the fact that many women cannot keep themselves sufficiently clean and further wound infections occur. As a result, the women affected are often perceived as “unclean” because of the smell and are rejected from society. In most cases, this leads to the isolation and stigmatization of women; they can no longer live in the community or with their families.

It is particularly drastic that the women affected are often their socio-cultural tasks such as reproduction - becoming pregnant and giving birth is impossible in most cases of fistula disease - or can no longer do housework. For many fistula patients, this results in a loss of their own identity, loneliness, social isolation, low self-esteem and great shame. In addition, many women affected are no longer able to pursue their economic activities and thus no longer support their families financially. This in turn leads to a feeling of dependence and uselessness.

In addition, for many patients there is mourning for the child, which in most cases died during childbirth, and the fear of being infertile from now on .

therapy

Treatment is usually carried out by surgical closure of the fistula at an early stage. Possible access routes are through the vagina or, in more complicated cases, through the abdominal wall. Depending on the diameter of the fistula, a flap may be required. B. is taken from the deep fat tissue of the labia (so-called Martius interposition flap ). 85% of vesicovaginal fistulas can be closed successfully on the first attempt.

In addition to the WHO , various charitable organizations are trying to improve the care of those affected in the third world, e. B. the US Fistula Foundation and Worldwide Fistula Fund or the Swiss aid organization Women's Hope International . The Addis Ababa Fistula Hospital specializes exclusively in this disease. One of the largest specialist clinics for the operation of obstetric fistulas is CCBRT in Dar es Salaam, Tanzania. In Birendranagar, Nepal, in the Surkhet district , TERRA TECH has had the country's first training hospital for the treatment of obstetric fistulas built since the end of 2016.

History

Avicenna described the typical symptoms after difficult births in his work Qānūn at-Tibb ( Canon of Medicine ) in the first half of the 11th century and saw the cause of the difficult birth in the premature marriage of young girls. In 1597, the Basel doctor Felix Platter also mentioned the bladder-vaginal fistula that occurs after births. The anthropologist Douglas Erith Derry reported in 1935 that he had found a large vesicovaginal fistula during his autopsy of the mummy of Henhenet (approx. 2050 BC, concubine of Mentuhotep II ) in 1923 . The Amsterdam surgeon Hendrik van Roonhuyse (1625–1672) carried out an operation to close such a urinary fistula for the first time in 1663.

In 1852, the American gynecologist James Marion Sims (1813-1883) in Montgomery (Alabama) published an operation method for treating bladder-vaginal fistula, which he tested on African -American female slaves and which made him internationally known.

See also

literature

  • A. Haferkamp, ​​N. Wagener, S. Buse, A. Reitz, J. Pfitzenmaier, P. Hallscheidt, M. Hohenfellner: Vesicovaginale Fisteln . In: The Urologist . tape 44 , no. 3 , edition A, 2005, p. 270-276 , doi : 10.1007 / s00120-005-0766-z .
  • Committee 18: Fistulas in the Developing World. In: Incontinence. 4th International Consultation on Incontinence, Paris July 5-8, 2008. Health Publication Ltd 2009, ISBN 0-9546956-8-2 ( icsoffice.org PDF; 2.1 MB).
  • Andreas Ommer, Alexander Herold, Eugen Berg, Alois Fürst, Thomas Schiedeck, Marco Sailer: German S3-Guideline. Rectovaginal fistula . In: GMS German Medical Science . tape 10 , October 29, 2012, ISSN  1612-3174 , p. Doc15 , doi : 10.3205 / 000166 , PMID 23255878 , PMC 3525883 (free full text).
  • Naguib Mahfouz: Genitourinary fistulae: General survey. In: Abdel Fattah Youssef (Ed.): Gynecological urology. Springfield / Ill. 1960.

Individual evidence

  1. ^ T. Margolis, LJ Mercer: Vesicovaginal fistula. In: Obstetrical & Gynecological Survey. Volume 49, Number 12, December 1994, pp. 840-847, ISSN  0029-7828 . PMID 7885661 . (Review).
  2. ^ GL Smith, G. Williams: Vesicovaginal fistula. In: BJU International . 1999, 83: pp. 564-569. PMID 10210608 . (Review).
  3. ↑ a b M. Muleta: Obstetric fistula in developing countries: a review article ( Memento of the original from December 20, 2015 in the Internet Archive ) Info: The @1@ 2Template: Webachiv / IABot / www.jogc.com archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 576 kB). In: Journal of obstetrics and gynecology Canada. Volume 28, Number 11, November 2006, pp. 962-966, ISSN  1701-2163 . PMID 17169220 . (Review).
  4. ^ Lewis Wall: Obstetric vesicovaginal fistula as an international public-health problem. Retrieved October 10, 2016 .
  5. ↑ a b Women’s Hope. .womenshope.ch, accessed on October 10, 2016 .
  6. ↑ Lilian T. Mselle, Thecla W. Kohi: Living with constant leaking of urine and odor. Thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania . In: BMC Women's Health . tape January 15 , 2015, ISSN  1472-6874 , p. 107 , doi : 10.1186 / s12905-015-0267-1 .
  7. ↑ who.int
  8. ↑ fistulafoundation.org
  9. ↑ worldwidefistulafund.org
  10. ↑ ccbrt.or.tz
  11. ^ Nepal - mother-child health. TERRA TECH Förderprojekte eV, accessed on May 22, 2017 .
  12. ^ Mark D. Walters, Mickey M. Karram: Urogynecology and Reconstructive Pelvic Surgery . Elsevier Health Sciences, 2006, ISBN 0-323-08191-6 , pp. 1731 ( books.google.com ).
  13. ↑ Horst Kremling : Gynecological-urological borderline questions. In: Würzburg medical history reports. 23, 2004, pp. 204-216; here: p. 204.
  14. ↑ Horst Kremling: On the history of birth-related bladder injuries. In: Würzburg medical history reports. 4, 1986, pp. 5-8; here: p. 5.
  15. ↑ DE Derry: Note on five pelves of women of the eleventh dynasty in Egypt. In: The Journal of Obstetrics and Gynaecology of the British Empire 42, 1935, p. 490.
  16. ↑ Jürgen Konert, Holger G. Dietrich: Illustrated history of urology . Springer, Berlin / Heidelberg / New York / Hong Kong / London / Milan / Paris / Tokyo 2004, ISBN 3-540-08771-0 , pp. 5 ( books.google.com ).
  17. ↑ Horst Kremling: On the history of birth-related bladder injuries. 1986, p. 5.
  18. ↑ Horst Kremling: Gynecological-urological borderline questions. 2004, p. 205.
  19. ^ J. Marion Sims: On the treatment of vesico-vaginal fistula. In: American Journal of the Medical Sciences. Volume 23, 1852, pp. 59-82.
  20. ↑ Barbara I. Tshisuaka: Sims, James Marion. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1334.