{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T03:16:44Z","timestamp":1793848604793,"version":"4.6.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified, and their records were reviewed retrospectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort, genitourinary fistulas were more common in multiparous women (9\/11), and rectovaginal fistulas were more common in primiparous women (24\/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina, and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65% of cases. Women who suffered from rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended fistula repair in the context of a subsequent delivery. For the first time, pregnancy-related changes in the vaginal wall were used to optimize the success rate of fistula closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In developed countries, birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, management must be tailored to the underlying pathology and the surgeon\u2019s experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Although vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient, and a vesicovaginal fistula should be ruled out.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial registration<\/jats:italic>\n                      Retrospectively registered, DRKS 00022543, 28.07.2020.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-021-01175-x","type":"journal-article","created":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T07:09:02Z","timestamp":1612508942000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9676-5395","authenticated-orcid":false,"given":"Christl","family":"Reisenauer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian","family":"Amend","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudius","family":"Falch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Abele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Yvonne","family":"Brucker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Andress","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,5]]},"reference":[{"key":"1175_CR1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13035","author":"R Pope","year":"2020","unstructured":"Pope R, Beddow M. A review of surgical procedures to repair obstetric fistula. Int J Gynaecol Obstet. 2020. https:\/\/doi.org\/10.1002\/ijgo.13035.","journal-title":"Int J Gynaecol Obstet"},{"key":"1175_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4413-x","author":"C Reisenauer","year":"2017","unstructured":"Reisenauer C. Presentation and management of vesicovaginal fistulae after delivery at a German women\u2019s hospital. Arch Gynecol Obstet. 2017. https:\/\/doi.org\/10.1007\/s00404-017-4413-x.","journal-title":"Arch Gynecol Obstet"},{"key":"1175_CR3","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-015-2860-0","author":"C Reisenauer","year":"2016","unstructured":"Reisenauer C. Presentation and management of rectovaginal fistulas after delivery. Int Urogynecol J. 2016. https:\/\/doi.org\/10.1007\/s00192-015-2860-0.","journal-title":"Int Urogynecol J"},{"key":"1175_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4350-8","author":"C Reisenauer","year":"2017","unstructured":"Reisenauer C, Hoopmann M. Vesico-uterine fistula in pregnancy. Arch Gynecol Obstet. 2017. https:\/\/doi.org\/10.1007\/s00404-017-4350-8.","journal-title":"Arch Gynecol Obstet"},{"key":"1175_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.05.012","author":"A Browning","year":"2015","unstructured":"Browning A, Whiteside S. Characteristics, management, and outcomes of repair of rectovaginal fistula among 1100 consecutive cases of female genital tract fistula in Ethiopia. Int J Gynaecol Obstet. 2015. https:\/\/doi.org\/10.1016\/j.ijgo.2015.05.012.","journal-title":"Int J Gynaecol Obstet"},{"key":"1175_CR6","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S106645","author":"J Wright","year":"2016","unstructured":"Wright J, Ayenachew F, Ballard KD. The changing face of obstetric fistula surgery in Ethiopia. Int J Womens Health. 2016. https:\/\/doi.org\/10.2147\/IJWH.S106645.","journal-title":"Int J Womens Health"},{"key":"1175_CR7","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2445-3","author":"TJ Raassen","year":"2014","unstructured":"Raassen TJ, Ngongo CJ, Mahendeka MM. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. Int Urogynecol J. 2014. https:\/\/doi.org\/10.1007\/s00192-014-2445-3.","journal-title":"Int Urogynecol J"},{"key":"1175_CR8","volume-title":"Comprehensive gynecology","author":"VL Katz","year":"2007","unstructured":"Katz VL. Comprehensive gynecology. Philadelphia: MosbyElsevier; 2007."},{"key":"1175_CR9","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1016\/S0039-6109(02)00055-5","volume":"82","author":"TJ Saclarides","year":"2002","unstructured":"Saclarides TJ. Rectovaginal fistula Surg Clin N Am. 2002;82:1261\u201372.","journal-title":"Rectovaginal fistula Surg Clin N Am"},{"key":"1175_CR10","unstructured":"Institut f\u00fcr Qualit\u00e4t und Transparenz im Gesundheitswesen (IQTIG): www.bundesgesundheitsministerium.de\/service\/begriffe-von-a-z\/i\/iqtig.html"},{"key":"1175_CR11","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-017-3375-7","author":"I Ouedraogo","year":"2018","unstructured":"Ouedraogo I, Payne C, Nardos R, Adelman AJ, Wall LL. Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center. Int Urogynecol J. 2018. https:\/\/doi.org\/10.1007\/s00192-017-3375-7.","journal-title":"Int Urogynecol J"},{"key":"1175_CR12","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31826579e8","author":"MA Barone","year":"2012","unstructured":"Barone MA, Frajzyngier V, Ruminjo J, et al. Determinants of postoperative outcomes of female genital fistula repair surgery. Obstet Gynecol. 2012. https:\/\/doi.org\/10.1097\/AOG.0b013e31826579e8.","journal-title":"Obstet Gynecol"},{"key":"1175_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-016-0248-3","author":"A Delamou","year":"2016","unstructured":"Delamou A, Delvaux T, Beavogui AH, et al. Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice. Reprod Health. 2016. https:\/\/doi.org\/10.1186\/s12978-016-0248-3.","journal-title":"Reprod Health"},{"key":"1175_CR14","doi-asserted-by":"publisher","DOI":"10.1055\/a-0938-7010","author":"C Reisenauer","year":"2019","unstructured":"Reisenauer C. Surgical management of obstetric rectovaginal fistulas: the gynaecological point of view. Zentralbl Chir. 2019. https:\/\/doi.org\/10.1055\/a-0938-7010.","journal-title":"Zentralbl Chir"},{"key":"1175_CR15","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-63031-6","author":"J Hamner","year":"2020","unstructured":"Hamner J, Florian-Rodriguez M, Acevedo J, et al. Protease inhibition improves healing of the vaginal wall after obstetrical injury: results from a preclinical animal model. Sci Rep. 2020. https:\/\/doi.org\/10.1038\/s41598-020-63031-6.","journal-title":"Sci Rep"},{"key":"1175_CR16","volume-title":"WHO recommendation on duration of bladder catheterization after surgical repair of simple obstetric urinary fistula","author":"World Health Organization","year":"2018","unstructured":"World Health Organization. WHO recommendation on duration of bladder catheterization after surgical repair of simple obstetric urinary fistula. Geneva: World Health Organization; 2018."},{"key":"1175_CR17","volume-title":"WHO handbook for guideline development","author":"World Health Organization","year":"2014","unstructured":"World Health Organization. WHO handbook for guideline development. Geneva: World Health Organization; 2014."},{"key":"1175_CR18","first-page":"15","volume":"10","author":"A Ommer","year":"2012","unstructured":"Ommer A, Herold A, Berg E, Fuerst A, Schiedeck T, Sailer M. German S3-Guideline: rectovaginal fistula. Ger Med Sci. 2012;10:15.","journal-title":"Ger Med Sci."}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-021-01175-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12905-021-01175-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-021-01175-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T07:10:23Z","timestamp":1612509023000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcwomenshealth.biomedcentral.com\/articles\/10.1186\/s12905-021-01175-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,5]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1175"],"URL":"https:\/\/doi.org\/10.1186\/s12905-021-01175-x","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-123755\/v1","asserted-by":"object"}]},"ISSN":["1472-6874"],"issn-type":[{"value":"1472-6874","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,5]]},"assertion":[{"value":"26 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The project was approved by the local ethics committee (Ethik-Kommission an der Medizinischen Fakult\u00e4t der Eberhard-Karls-Universit\u00e4t und am Universit\u00e4tsklinikum T\u00fcbingen) with reference number 447\/2020BO. We used the STROBE cohort reporting guidelines (von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies). Verbal and written informed consent was obtained from all the patients for the scientific evaluation and publication of their data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patients gave written consent for their personal or clinical details and any identifying images to be published in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"52"}}