Capes Tracy, Ascher-Walsh Charles, Abdoulaye Idrissa, Brodman Michael
Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School of Medicine, New York, NY, USA.
Mt Sinai J Med. 2011 May-Jun;78(3):352-61. doi: 10.1002/msj.20265.
Vesicovaginal fistula secondary to obstructed labor continues to be an all-too-common occurrence in underdeveloped nations throughout Africa and Asia. Vesicovaginal fistula remains largely an overlooked problem in developing nations as it affects the most marginalized members of society: young, poor, illiterate women who live in remote areas. The formation of obstetric fistula is a result of complex interactions of social, biologic, and economic influences. The key underlying causes of fistula are the combination of a lack of functional emergency obstetric care, poverty, illiteracy, and low status of women. In order to prevent fistula, some strategies include creation of governmental policy aimed toward reducing maternal mortality/morbidity and increasing availability of skilled obstetric care, as well as attempts to increase awareness about its prevention and treatment among policymakers, service providers, and communities. Whereas prevention will require the widespread development of infrastructure within these developing countries, treatment of fistula is an act which can be done "in the now." Treatment and subsequent reintegration of fistula patients requires a team of specialists including surgeons, nurses, midwives, and social workers, which is largely unavailable in developing countries. However, there is increasing support for training of fistula surgeons through standardized programs as well as establishment of rehabilitation centers in many nations. The eradication of fistula is dependent upon building programs that target both prevention and treatment.
在非洲和亚洲的欠发达国家，梗阻性分娩继发的膀胱阴道瘘仍然屡见不鲜。在发展中国家，膀胱阴道瘘在很大程度上仍是一个被忽视的问题，因为它影响着社会中最边缘化的群体：居住在偏远地区的年轻、贫困、文盲妇女。产科瘘的形成是社会、生物和经济影响等复杂相互作用的结果。瘘的关键根本原因是缺乏有效的紧急产科护理、贫困、文盲以及妇女地位低下。为了预防瘘，一些策略包括制定旨在降低孕产妇死亡率/发病率和增加熟练产科护理可及性的政府政策，以及努力提高政策制定者、服务提供者和社区对其预防和治疗的认识。虽然预防需要在这些发展中国家广泛发展基础设施，但瘘的治疗是当下就可以进行的行动。瘘患者的治疗及后续重新融入需要一个由外科医生、护士、助产士和社会工作者等组成的专家团队，而这在发展中国家基本无法实现。然而，越来越多的人支持通过标准化项目培训瘘外科医生，并在许多国家建立康复中心。根除瘘取决于建立兼顾预防和治疗的项目。
