Fistula retro dan uretro vagina presentasi.pptx

Fistula retrovagina dan uretro vagina

1. Vesikovaginal fistula & Rektovaginal fistula Aliffudin Nuur Semester II Program Pendidikan Dokter Spesialis Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sebelas Maret Rumah Sakit dr. Moewardi Surakarta 20 21

2. Prolonged or obstructed labor  ischemic necrosis of anterior vaginal wall and bladder  fistula formation Obstetric trauma / C-section . Can occur immediately or few days after delivery, bigger diameter, infection, edema, and necrotic Hysterectomy (50.6 – 65%) (Lee 1988, Hilton 2006) Intraoperative: Anatomical distortion due to tumor/ endometriosis Vesica was not detach long enough Vesika was being sutured when suturing the cuff Occur in the 5 th -14 th day after operation Obstetrics Fistula Gynecologic Fistula 2

3. Klasifkasi berdasarkan besarnya fistula : 1 Simpel Kecil ( ≤ 2.5 cm) Letak rendah Etiologi : infeksi atau trauma Biasanya memiliki jaringan yang baik disekitarnya Kompleks besar (>2.5 cm) letak tinggi tinggi Etiologi : IBD , fistula berulang 1. deBeche-Adams,et al. Clinics in colon and rectal surgery  23.2 (2010): 99. 3

4. There is no infection / inflammation. Usually wait until 3 months Collin is giving 100mg of cortisone pre operative for 10 – 14 days 4

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6. Management post- operasi Hindari paparan tinja dan urin pada luka bekas operasi Hindari konstipasi dan enema Diet lunak selama 3 hari diikuti dengan diet rendah residu selama 2 minggu Pemberian obat pelunak feses Antibiotik postoperative 5-7 hari 2,3 Contoh : Cefuroxime dan Metronidazole selama 5 hari Kateter dipertahankan selama 2 minggu Ommer , Andreas, et al. "German S3-Guideline: rectovaginal fistula."  GMS German Medical Science  10 (2012). Rahman , M. S., et al. Journal of Obstetrics & Gynecology  23.6 (2003): 607-610. Zimmerman, Carl W., ed.  Advances in reconstructive vaginal surgery . Lippincott Williams & Wilkins, 2012.p385-400 6

7. Terima Kasih 7