Department of Pelvic Reconstructive Surgery, Zeynep Kamil Maternity Hospital, Istanbul, Turkey.
Taiwan J Obstet Gynecol. 2010 Sep;49(3):291-6. doi: 10.1016/S1028-4559(10)60063-0.
Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa).
Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary. According to their clinical condition, women were informed and surgical options offered as appropriate. Operations were performed under spinal or epidural anesthesia. Immediate postoperative outcomes were followed during the stay of the surgical team in the country.
A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula. In 9.8% of the women, severe local infection precluding any surgical intervention was evident. In 58.8% of patients, the trigonal region and/or urethra were irreversibly damaged. A proportion of patients (9.8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention. Of the women that were operated on (21.6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino-vaginal approach.
It is extremely difficult to meet the needs of this global problem with short term programs and volunteers. Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal.
评估尼日尔（非洲）一家地区医院自主瘘管运动中遇到的问题。
对女性进行基本的妇科检查、亚甲蓝测试和/或直接膀胱镜检查（视需要而定）。根据她们的临床情况，向女性告知并提供适当的手术选择。手术在脊髓或硬膜外麻醉下进行。在手术团队在该国停留期间，对术后即刻的结果进行随访。
共检查了 62 名女性，其中 11 名女性的尿失禁原因并非产科瘘管。在 9.8%的女性中，存在严重的局部感染，妨碍了任何手术干预。在 58.8%的患者中，三角区和/或尿道不可逆转地受损。一部分（9.8%）有大病灶且尿道完整的患者拒绝接受阴道分层闭合的干预。接受手术的女性（21.6%）中，有 6 人接受了 Martius 脂肪瓣阴道分层闭合术，5 人接受了腹-阴道联合入路手术。
通过短期项目和志愿者来满足这一全球性问题的需求极其困难。将这些努力导向专门的瘘管中心并创建可靠的科学证据应成为主要目标。
