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Surgical classification of obstetric fistulas
Author(s) -
Waaldijk K.
Publication year - 1995
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/0020-7292(95)02350-l
Subject(s) - medicine , general surgery , surgery , obstetrics
Objective: To develop a surgical classification for obstetric fistulas in order to compare surgical techniques and results. Methods: Based on a retrospective analysis of 775 consecutive fistula patients, the following classification is presented: (type I) fistulas not involving the urethral closing mechanism; (type II) fistulas involving the urethral closing mechanism; and (type III) ureter and other exceptional fistulas. Type II fistulas can be further divided into: (A) without (sub)total urethra involvement, and (B) with (sub)total urethra involvement; and (a) without a circumferential defect, and (b) with a circumferential defect. This classification was applied prospectively in over 2700 consecutive fistula patients. Results: The surgical technique becomes progressively more complicated from type I through type IIBb. The results of closure and continence worsen progressively from type I through type IIBb. Personal experience in the case of type III fistulas is very limited. Conclusion: This classification enables a systematic comparison of different surgical techniques and an objective evaluation of results from different centers.