Obstetric Fistula, Softcover reprint of the original 1st ed. 1988

Obstetric fistula is as old as mankind. While the incidence has diminished progressively with better health care in Western societies, the situation has changed little in many developing countries. Fistulae of pelvic organs, often monstrous defects, still are a major complication of child-birth causing misery to uncounted young women, and if they cannot find help in one of the very few hospitals with trained specialists, they became urological cripples losing everything: family, home and job. The magnitude of the problem is illustrated by some figures given by Reginald and Catherine Hamlin-about 700 fistula patients treated each year-a total of over 10,000 cases operated upon in their fistula hospital in Addis Ababa, Ethio­ pia. Most of these injuries could be prevented by better health care at the village level as some studies have shown conclusively. The incidence of fistula is an indicator of the standard of health and obstetrical care. The author of this book-Obstetric Fistula-is an internationally known Australian gynaecologist who for many years has been interested in all aspects of gynaecological urology, especially urinary stress inconti­ nence, other forms of involuntary loss of urine, and associated gynaeco­ logical conditions. He has devised a number of new operations to treat pelvic defects. Robert Zacharin's interest in obstetric fistula was a con­ sequence of his surgical activity in developing countries.

Historical Introduction.- The Era Before James Marion Sims.- James Marion Sims (1813–1883) and the First Fistula Hospital.- The Post-Sims Era.- Fistula Surgeons in the Modern Era.- The Hamlins of Ethiopia and the Second Fistula Hospital.- The Incidence, Etiology and Pathology of Obstetric Fistula.- Incidence.- Etiology.- i) Spontaneous Development.- ii) Fistulae Due to Trauma.- iii) Social Factors.- iv) Traditional Genital Tract Injury and Mutilation.- v) The Influence of Bilharzia.- vi) Social Consequences of Genital Fistula.- Pathology of Obstetric Fistula.- i) Pressure Necrosis.- ii) Healing Phase.- iii) Associated Diseases and Conditions.- Management of Urinary Fistulae.- Clinical Features.- i) Classification.- ii) Symptoms.- iii) Diagnosis and Investigation.- Fistulae Involving the Urinary System—Clinical Groups.- Surgical Correction.- i) Prophylaxis.- ii) Difficulties Associated with Urinary Fistulae.- iii) Methods Available for Surgical Correction.- Cauterization.- Vaginal Surgery.- Abdominal Surgery—the Transvesical Extraperioneal Approach.- Transvesical Intraperitoneal Approach.- Combined Abdomino-Vaginal Approach.- Colpocleisis.- Transplantation of Ureters.- Unorthodox Approaches.- iv) Choice of Surgical Approach.- Principles of Vaginal Closure.- 1. Immediate Preoperative Requirements.- 2. Adequate Exposure.- 3. Assessment Under Anesthesia.- 4. Mobilization.- 5. Excision of Scar Tissue.- 6. Care of the Ureters.- 7. Bladder Wall Closure.- 8. Grafting.- 9. Closing the Vaginal Skin.- 10. Vaginal Pack.- 11. Postoperative Management.- Complications.- Recto- Vaginal Fistula.- Etiology.- Clinical Features.- Surgical Correction.