Abstract：
Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation.
This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both).
Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women.
Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.
This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both).
Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women.
Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.
摘要：
背景：大多数生殖器瘘是由于延长，难产或手术并发症。其他原因包括创伤（事故，传统治疗师，或性暴力)，辐射,癌,感染,不安全堕胎,先天性畸形.
方法：本回顾性记录综述集中在1980年后发展为瘘管并在1994年至2017年期间在坦桑尼亚寻求治疗的6,787名妇女中的罕见瘘管原因。乌干达，肯尼亚,马拉维,赞比亚，卢旺达,埃塞俄比亚,索马里,南苏丹。我们比较了各国的瘘管病因，并评估了罕见原因和失禁类型之间的关联（尿液，粪便,或两者)。
结果：罕见瘘管占所有瘘管的1.12%（76/6,787），包括创伤事故(19/6,787，0.28%)，创伤性性暴力（15/6,787，0.22%），传统治疗师造成的创伤(13/6,787，0.19%)，不安全流产（10/6,791，0.15％），辐射（8/6,787，0.12%），HIV感染并发症（6/6,787，0.09%），先天性异常（5/6,787，0.07%）。传统治疗师造成的创伤是索马里妇女的一个特殊问题。
结论：由罕见原因引起的瘘阐明了女性面临的各种风险。瘘修复培训材料应区分由传统治疗师引起的创伤作为独特的瘘病因。瘘的不同原因需要多管齐下的策略来减少瘘的发生率。
方法：本回顾性记录综述集中在1980年后发展为瘘管并在1994年至2017年期间在坦桑尼亚寻求治疗的6,787名妇女中的罕见瘘管原因。乌干达，肯尼亚,马拉维,赞比亚，卢旺达,埃塞俄比亚,索马里,南苏丹。我们比较了各国的瘘管病因，并评估了罕见原因和失禁类型之间的关联（尿液，粪便,或两者)。
结果：罕见瘘管占所有瘘管的1.12%（76/6,787），包括创伤事故(19/6,787，0.28%)，创伤性性暴力（15/6,787，0.22%），传统治疗师造成的创伤(13/6,787，0.19%)，不安全流产（10/6,791，0.15％），辐射（8/6,787，0.12%），HIV感染并发症（6/6,787，0.09%），先天性异常（5/6,787，0.07%）。传统治疗师造成的创伤是索马里妇女的一个特殊问题。
结论：由罕见原因引起的瘘阐明了女性面临的各种风险。瘘修复培训材料应区分由传统治疗师引起的创伤作为独特的瘘病因。瘘的不同原因需要多管齐下的策略来减少瘘的发生率。
