Surgical classification of obstetric fistulas
Waaldijk, K.
International Journal of Gynaecology and Obstetrics the Official Organ of the International Federation of Gynaecology and Obstetrics 49(2): 161-163
1995
ISSN/ISBN: 0020-7292 PMID: 7649321 DOI: 10.1016/0020-7292(95)02350-lDocument Number: 313930
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.