Hilton Paul
Newcastle University, Newcastle upon Tyne, UK.
Int Urogynecol J. 2016 Jun;27(6):831-7. doi: 10.1007/s00192-015-2919-y. Epub 2016 Jan 7.
It has long been held as conventional wisdom that urogenital fistulae in low-income and middle-income countries are almost exclusively of obstetric aetiology, related to prolonged neglected obstructed labour, whereas those seen in high-income countries are largely iatrogenic in nature. There is, however, a growing perception amongst those working in the field that an increasing proportion of urogenital fistulae in low-income and middle-income countries may be iatrogenic, resulting from caesarean section. Recent studies suggest that adverse patterns of care may also be emerging in high-income countries; an increase in the risk of both vesicovaginal and ureterovaginal fistulae following hysterectomy has been reported, concurrently with the reduction in overall use of the procedure. These apparent secular trends are discussed in the context of evolution of practice, teaching and training in obstetrics and gynaecology.
长期以来，传统观点认为，低收入和中等收入国家的泌尿生殖瘘几乎完全由产科病因引起，与长期被忽视的梗阻性分娩有关，而在高收入国家看到的泌尿生殖瘘在很大程度上是医源性的。然而，该领域的工作人员越来越多地认为，低收入和中等收入国家中越来越大比例的泌尿生殖瘘可能是医源性的，由剖宫产引起。最近的研究表明，高收入国家也可能出现不良的护理模式；据报道，子宫切除术后膀胱阴道瘘和输尿管阴道瘘的风险增加，同时该手术的总体使用量减少。本文在妇产科实践、教学和培训的演变背景下讨论了这些明显的长期趋势。
