Current practices in treatment of female genital fistula: a cross sectional study
Current practices in treatment of female genital fistula: a cross sectional study
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DOI：
10.1186/1471-2393-10-73
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发表时间：
2010-11-10
影响因子：
3.1
通讯作者：
Landry, Evelyn G.
中科院分区：
文献类型：
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作者：
Arrowsmith, Steven D.;Ruminjo, Joseph;Landry, Evelyn G.
背景：在大多数发达国家，孕产妇结局良好。然而，在许多发展中国家/资源贫乏的国家，孕产妇的结局更加暗淡：每年有50多万妇女死于分娩，其中大多数在资源贫乏的国家。那些幸存下来的人往往患有严重和长期的疾病。最具破坏性的伤害之一是产科瘘管病，最常发生在南亚和撒哈拉以南非洲。非洲和亚洲许多国家都提供瘘管治疗和护理，但缺乏与瘘管修复手术成功相关的临床因素的可靠数据。大多数已发表的研究都是回顾性的。虽然这些研究提供了关于瘘管的护理和治疗的有用信息，但它们受到设计的限制。本研究的目的是确定在护理的做法，可能会导致前瞻性和随机对照trials.Methods的设计：自我管理的问卷调查完成了40名外科医生已知在非洲和亚洲提供瘘管治疗服务的私人和政府医院。问卷分为三个部分，以解决以下问题：预防性使用抗生素之前，期间和瘘手术后;导尿管管理;和尿失禁患者的管理实践fistula repair.Results：结果提供了一个一瞥到目前的实践中瘘的治疗和护理在广泛的地理，经济和组织的考虑。在某些领域的治疗（常规使用预防性抗生素，有限的卧床休息，直到导管被删除，术后尿失禁的非手术治疗），而在其他领域的实践中有很大的差异（导管使用的持续时间，术后尿失禁的手术治疗）。这些研究结果是基于一个小样本，不允许建议改变临床护理，但他们指出可能的临床试验研究，这将有助于更有效和更有效的fistula care.Conclusions的问题：调查结果使我们能够考虑临床实践中最有影响力的成本，疗效和安全性的瘘管治疗。基于这些考虑，我们对8项随机对照试验提出了建议，这些试验涉及以下主题：1）短期导尿的有效性/安全性; 2）手术和非手术治疗尿失禁的有效性; 3）瘘管修复期间降低术后尿失禁发生率的技术措施; 4）确定“不可治愈瘘管”的预测因素; 5）尿动力学检查在尿失禁治疗中的作用; 6）瘘管人群中多重耐药细菌的发生率和意义; 7）通过导管引流对小的新瘘管进行初级治疗; 8）瘘管修复中的抗生素预防。
Background: Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials.Methods: Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair.Results: The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for possible clinical trial research that would contribute to more efficient and effective fistula care.Conclusions: The findings from the survey allowed us to consider clinical practices most influential in the cost, efficacy, and safety of fistula treatment. These considerations led us to formulate recommendations for eight randomized controlled trials on the following subjects: 1) Efficacy/safety of short-term catheterization; 2) efficacy of surgical and nonsurgical therapies for urinary incontinence; 3) technical measures during fistula repair to reduce the incidence of post-surgery incontinence; 4) identification of predictive factors for "incurable fistula"; 5) usefulness of urodynamic studies in the management of urinary incontinence; 6) incidence and significance of multi-drug resistant bacteria in the fistula population; 7) primary management of small, new fistulas by catheter drainage; and 8) antibiotic prophylaxis in fistula repair.