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LETTER TO EDITOR
Year : 2011  |  Volume : 3  |  Issue : 2  |  Page : 114  

Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital, important issues missed


1 Department of Urology, Bhopal Memorial Hospital & Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Surgery, MGM Medical College & Hospital, Kamothe, Navi Mumbai, Maharashtra, India

Date of Web Publication17-Jun-2011

Correspondence Address:
Ankur Hastir
Department of Surgery, MGM Medical College & Hospital, Kamothe, Navi Mumbai - 410 209, Maharashtra
India
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DOI: 10.4103/0974-7796.82183

PMID: 21747607

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How to cite this article:
Singh O, Gupta SS, Hastir A. Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital, important issues missed. Urol Ann 2011;3:114

How to cite this URL:
Singh O, Gupta SS, Hastir A. Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital, important issues missed. Urol Ann [serial online] 2011 [cited 2019 Sep 21];3:114. Available from: http://www.urologyannals.com/text.asp?2011/3/2/114/82183

Sir,

We read the article by Mathur et al. [1] with a lot of interest. The authors have provided their experience of 50 cases of urogenital fistulae (UGF). But we felt that some important points must have been highlighted while getting experience of such an important topic. Currently, the management of UGF is well established, with various authors even from developing countries presenting their experience of hundreds of patients. [2] What this topic needs is light on the current controversies. Authors claim it to be a prospective study (started in 2005) completely ignoring important issues like early repair versus late repair, approach for surgery (vaginal vs. abdominal, intra- vs. extra-peritoneal), type, and outcome with different intervening tissues used in repair. According to the abstract and introduction, the objective of this study was to "enunciate the patient demography, patient profile, incidence, type of surgery, and also the long-term outcomes" of the management of UGF. But it is surprising to find that there is no mention at all of the type of surgery. Moreover, authors included patients until July 2009, and declared the results in December 2009. How have they measured the long-term results? Authors themselves have stressed upon the burden of UGF in developing countries. Do they think the experience of just 50 cases should get a place in the standing glorious literature? Everything appears old in this self-proclaimed prospective study. The article had some other flaws too: no mention of the time of the development of fistulae after obstetric labor or the types of congenital fistulae seen (two cases). Healing by conservative treatment in six cases (12%) is a very high rate. There is no mention of how this was achieved. This would be really helpful to the contemporary urologists if such a high percentage of UGF start healing by conservation! After 5 year of prospective experience, there is no mention of the characteristics/predictors in favor of or against spontaneous healing. It is also surprising that recurrence rates were not found. Ten percent loss to follow-up is significant. Usually, the follow-up losses are excluded from the patient cohort. The authors concluded that "prevention is better than cure." But how to prevent it is not mentioned. Also, it is surprising that authors did not encounter any case of ureterovaginal fistula that have an incidence of 10%. Above all, rectovaginal fistulae are not included in "urogenital fistulae" in any standard classification. An article on such an important topic with a high impact on public health is not expected to have such less number of references, missing the important ones from the abundant literature. We do not want to offend the authors, but the article lacks data and appears to have little value, if any, for the contemporary urologists.

 
   References Top

1.Mathur R, Joshi N, Aggarwal G, Raikwar R, Shrivastava V, Mathur P, et al. Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital. Urol Ann 2010;2:67-70.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Wall LL, Karshima JA, Kirschner C, Arrowsmith SD. The obstetric vesicovaginal fistula: characteristics of 899 patients from Jos, Nigeria. Am J Obstet Gynecol 2004;190:1011-9.  Back to cited text no. 2
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