From the Barhirdar Hamlin Fistula Centre, Barhirdar, Ethiopia; and the Department of Obstetrics and Gynecology and the Department of Anthropology, Washington University, St. Louis, Missouri.
Obstet Gynecol. 2010 Mar;115(3):578-583. doi: 10.1097/AOG.0b013e3181d012cd.
To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor.
A comparison was made between 255 fistula patients who had undergone type I or type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age; parity; length of labor; labor outcome (stillbirth or not); type of fistula; site, size, and scarring of fistula; outcomes of surgery (fistula closed; persistent incontinence with closed fistula; urinary retention with overflow; site, size, and scarring of any rectovaginal fistula; and operation outcomes), and specific methods used during the operation (use of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure.
The only statistically significant differences between the two groups (P=.05) were a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, a slightly higher use of a pubococcygeal sling at the time of fistula repair, and a slightly longer length of labor (by 0.3 day) in women who had undergone genital cutting.
Type I and type II female genital cutting are not independent causative factors in the development of obstetric fistulae from obstructed labor.
评估女性生殖器切割与分娩时梗阻导致的膀胱阴道瘘形成之间的任何关联。
将 255 名接受过 I 型或 II 型女性生殖器切割术的瘘管患者与 237 名未接受过此类切割术的患者进行比较。这些女性均在埃塞俄比亚的巴希达林·哈林瘘管中心接受手术。分析中使用的数据点包括年龄；产次；分娩时长；分娩结果（死产或非死产）；瘘管类型；瘘管位置、大小和瘢痕情况；手术结果（瘘管闭合；闭合瘘管仍持续失禁；尿液潴留伴溢尿；任何直肠阴道瘘的位置、大小和瘢痕；以及手术结果），以及手术过程中使用的特定方法（是否使用移植物、应用耻骨尾骨或类似的自体吊带、阴道成形术、输尿管置管术以及阴道瓣重建术）。主要结局是泌尿生殖瘘的位置和尽管瘘管成功闭合仍持续失禁。
两组之间唯一具有统计学意义的差异（P=.05）是未接受生殖器切割手术的女性在手术时需要放置输尿管导管的可能性略大，在修复瘘管时使用耻骨尾骨吊带的可能性略高，以及接受生殖器切割的女性的分娩时长略长（长 0.3 天）。
I 型和 II 型女性生殖器切割术不是分娩时梗阻导致的产科瘘形成的独立致病因素。
