Ramphal Suran, Moodley Jagidesa
Department of Obstetrics and Gynaecology and MRC/UKZN Pregnancy Hypertension Research Unit, University of KwaZulu-Natal, Durban, South Africa.
Curr Opin Obstet Gynecol. 2006 Apr;18(2):147-51. doi: 10.1097/01.gco.0000192980.92223.2d.
Obstetric fistula has a devastating impact on the lives of women in poor countries. Currently, there is an international campaign by the World Health Organisation, United Nations Population Fund and other bodies to address this problem. This article reviews recent literature and highlights the paucity of evidence-based data.
Articles on the pathophysiology, co-morbidities and sequelae including physical injury to 'multiorgan systems' and social consequences associated with obstetric fistula, are discussed. In particular, the devastating social, economic and psychological effects on the health and well-being, reintegration and rehabilitation are addressed. There is a need for prevalence and incidence studies to measure the extent of this problem. The creation of well-equipped fistula centres with multidisciplinary teams to evaluate patients should be the aim. Expert surgeons and optimal databases with personnel to do research will benefit patients.
Prevention should involve alleviation of poverty and improvement in education, maternity services and health. Research on issues such as persistent stress incontinence following fistula closure, management of reduced bladder capacity, best technique for fistula repair, role of vaginoplasty, role of early repair in selective obstetric fistula, future reproductive function, dermatological management, and social and cultural issues must be done to improve women's health.
产科瘘对贫困国家妇女的生活产生了毁灭性影响。目前，世界卫生组织、联合国人口基金及其他机构发起了一项国际运动来解决这一问题。本文回顾了近期文献，并强调了循证数据的匮乏。
讨论了有关产科瘘的病理生理学、合并症及后遗症的文章，包括对“多器官系统”的身体损伤以及相关社会后果。特别提到了对健康与幸福、重新融入社会及康复所造成的毁灭性社会、经济和心理影响。需要开展患病率和发病率研究以衡量该问题的严重程度。目标应是建立配备完善的瘘管治疗中心，并组建多学科团队来评估患者。专业外科医生以及拥有研究人员的优化数据库将使患者受益。
预防措施应包括减轻贫困、改善教育、孕产妇服务和健康状况。必须对诸如瘘管闭合后持续性压力性尿失禁、膀胱容量减少的处理、瘘管修复的最佳技术、阴道成形术的作用、选择性产科瘘早期修复的作用、未来生殖功能、皮肤病学处理以及社会和文化问题等进行研究，以改善妇女健康。
