Falandry L
Service de Chirurgie Viscérale et d'Urologie, Université Omar Bongo, Libreville, Gabon.
Prog Urol. 1992 Oct;2(5):861-73.
A homogeneous series of 261 post-partum urogenital fistulae treated over the last ten years in Africa by the same operator is analysed. Mostly occurring in young, primiparous women in a rural environment, the predominant cause was neglected dystocic delivery in the bush (65.5%). The fistula was traumatic in 27.9% of cases and secondary to hysterectomy in 6.8%. 247 patients underwent surgical repair. The choice of repair procedure, generally performed via the transvaginal route (92.3%), was based on the anatomical classification of the various lesions into three groups of indications: Group I: simple fistulae (98), in which surgical treatment consisted of closing the fistula orifice by simple separate suture of the bladder and vagina, generally followed by success. Group II: more difficult fistulae (109) with severe tissue damage, raising the dual problem of continence and healing and requiring the use of mattressing with a well vascularised adjacent tissue (55 cases). Group III: complicated fistulae (54) with the presence of associated lesions, often requiring multiple urological, genital and intestinal operations as well as complementary plastic techniques (31 cases): double autoplasty of the labia major (17) and adipocutaneous pedicle skin flap (14). 212 of the 261 patients (81.2%) were cured, 23 obtained partial cure (insufficient continence, amenorrhoea, vaginal sclerosis making sexual activity impossible) and there were 26 failures. Urinary diversion was the only solution in 14 patients (7.8%). The objective in surgical correction of urogenital fistulae is twofold: to obtain good quality cure (81.2%), i.e. controlled micturition and a normal, genital, conjugal and social life. overcome the limitations of palliative operations which are always poorly accepted in Africa, at the cost of repeated, staged surgery designed to simplify the lesions in the most severely damaged cases. Prevention programmes designed to eradicate urogenital fistulae, which constitutes a real public health problem in developing countries, will only be made credible by an improvement in the quality of the results obtained in the treatment of this disease.
对同一医生在过去十年里于非洲治疗的261例产后泌尿生殖瘘病例进行了分析。这些病例大多发生在农村地区的年轻初产妇中，主要病因是丛林中难产被忽视（65.5%）。27.9%的病例瘘管是创伤性的，6.8%继发于子宫切除术。247例患者接受了手术修复。修复手术的选择通常通过经阴道途径进行（92.3%），其依据是将各种病变按解剖学分类为三组适应证：第一组：简单瘘管（98例），手术治疗包括通过膀胱和阴道的简单单独缝合关闭瘘口，通常随后获得成功。第二组：较难处理的瘘管（109例），伴有严重组织损伤，引发控尿和愈合双重问题，需要使用带良好血运的相邻组织进行褥式缝合（55例）。第三组：复杂瘘管（54例），伴有相关病变，常需要多次泌尿外科、妇科和肠道手术以及补充整形技术（31例）：大阴唇双自体成形术（17例）和带蒂脂肪皮瓣（14例）。261例患者中有212例（81.2%）治愈，23例获得部分治愈（控尿不足、闭经、阴道硬化导致无法进行性生活），26例治疗失败。14例患者（7.8%）唯一的解决办法是尿流改道。泌尿生殖瘘手术矫正的目标有两个：获得高质量治愈（81.2%），即排尿得到控制，拥有正常的生殖、婚姻和社会生活。克服姑息性手术的局限性，姑息性手术在非洲一直难以被接受，代价是进行反复的分期手术，旨在简化最严重受损病例中的病变。旨在根除泌尿生殖瘘的预防计划，这在发展中国家是一个真正的公共卫生问题，只有通过提高这种疾病治疗结果的质量才能让人信服。
