1 / 10

Presented by

Clifford R.Wheeless,Jr,M.D Associate professor The Kelly Gynecologist Oncology service JOHNS HOPKINS University School of medecine. Gynecology and Obstetrics 1006 st georges Road Baltimore MD 21210. Presented by.

dinos
Download Presentation

Presented by

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Clifford R.Wheeless,Jr,M.D Associate professor The Kelly Gynecologist Oncology service JOHNS HOPKINS University School of medecine Gynecology and Obstetrics 1006 st georges Road Baltimore MD 21210 Presented by

  2. Fistula is a form of birth trauma that is one of the most disabling condition women can experience. It takes from her family, children, vocation and feminity. It can be prevented and often repaired with continence in the majority of women.

  3. Our data base is in baltimore and therefore we do not have the result of all nine missions to Niger for fistula repair • Our data is available for the February 2005 mission. We accept for surgery all women of all stages and those with resent outset of fistula and those who have had multiple surgeries

  4. Our data is listed as « wet or dry », they are 3 sub groups • Group I:surgically reconstructed and wet from incontinence of urine/urge, mixed and internal sphincter deficiency) • Group II :wet from failure of fistula repair • Group III :dry ( surgically intact and no incontinence of urine)

  5. Stages We recognize 4 stages of fistula based on size , anatomy and function: • Stage I: is a fistula less than 1 cm without involving the urethra vesical Junction ( UVJ) or trigone. • Stage II: is a fistula greater than 2 cm ,less than 4 cm, without involvment of UVJ and trigone • Stage III: is a UVJ and less than 50% trigone or 3 previous surgeries • Stage IV:is absent UVJ and trigone

  6. Surgery All surgery on stage I,II,III, fistula is from the vaginal approach under spinal anesthesia Stage IV fistula and multi operated fistula are best approached through the abdomen and diverted with hemi Koch pouch to the recto sigmoid colon to achieve an adequate vaginal canal for intercourse and complete continence

  7. February mission • Our february mission in 2005 results are compatible with our previous mission: We operated on 55 women: Stage I:24 Stage II:23 Stage III:11

  8. Results • Of the 24 women stage I: 21 are dry (87%), and 3 are wet ( 2 From failure and 1 wet with incontinence) • Stage II: On the 23 patients : 19 dry, 4 wet ( all from fistula failure) • StageIII:8 patients 6 dry ( 75%) and 2 wet ( all from fistula failure)

  9. Conclusion • The weakness of this study is the small number of patient (power). • The strength is that it includes all patient and the data is prospectively calculated

  10. Thank you for your attention

More Related