A T Kidmas

Bio: A T Kidmas is an academic researcher. The author has contributed to research in topics: Uterine Fistula. The author has an hindex of 1, co-authored 1 publications receiving 32 citations.

Vesico-uterine fistula.

Abstract: protected ‘as clients often try to remove or even tear male condoms during sex.’ I believe this practice of removing or tearing the condom stems from the fact that some Malawian men (and women perhaps) believe that for sexual intercourse to be meaningful (an intimate social experience), there must be sharing of body fluids. Contact between mucosa to mucosa (nyama kwa nyama) is preferred and considered superior sex. Anything less than that is counterfeit. The female condom, despite being used in pilot studies and registering high acceptability rates, has not been widely accessible to the majority of the population as compared to the male condom. There were reports, as early as 1997, that UNAIDS wanted to improve the availability of the female condom in developing countries and now, almost a decade later, there seems not much progress has been made. Among the many reasons as to why the female condoms have not been readily available is the financial cost, as the female condom may cost up to 10 times as much as the male condom. The male condom continues to be sold at subsidized costs through social marketing efforts and is distributed for free to sexually transmitted infection (STI) and family planning clients in Malawi. The female condom on the other hand does not get that much attention. One of the reasons given for the lackluster promotion by social marketing organizations is that considering the gender power imbalances between men and women, it is the man who most often decides when and whether sexual intercourse is going to occur and whether a condom is going to be used or not. Promoting the male condom therefore makes much more sense than promoting the female condom, as it is deemed that the male condom target is the decisionmaker (man). Although the proportion of CSWs who perceived the female condom as unacceptable was rather small (2%), it is important that impaired sensation was mentioned as reason for unacceptability. Perception of diminished pleasure has also been mentioned as reasons for not using condoms in Indonesia. There are at least two points that can be said about this. There is some line of thought that CSWs do not mind whether sex is pleasurable or not. This thinking may not be always correct. The second idea is that if condoms (be they male or female) reduce sensation, it is possible that a significant number of people who would have used them may be prevented for using the condoms. As for CSWs, they risk losing clients and they are unlikely to accept such costs. While the perceived impairment of sensation by condoms has been mentioned in many studies, it seems there has not been a concerted effort to address this problem. For instance, while most of the condoms being promoted by social marketing organizations are the cheap ones (and although efficacious in preventing STIs), they may not be the most sexually sensitive ones. On the commercial market, there are condoms with a different thickness of latex, with ribs, with studs and other properties that could be made available widely also in order to deal with this problem of reduced ‘sweetness’ of the ‘conventional’ low-cost condoms. Yes, we may need to spend more. But we are becoming more ready to spend or ask for funding on antiretrovirals. I agree with the authors that there is preference of dry sex (as usual, for some) in Malawi and a much-lubricated condom is likely to be unacceptable to those preferring drier sex. Studies in Zimbabwe have also documented this preference for dry sex. That some of the CSWs in the study re-used the same female condom on consecutive clients would not have worried me much, had the male clients used male condoms also. It is possible these males did not use (male) condoms and that is worrying and a minus for the female condom. While I have no data to substantiate my claim, the likelihood of re-using the male condom on consecutive clients is smaller, I think. Adamson SMuula MBBSMPH

Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature.

Abstract: Herein we report on 1 more case of vesicouterine fistula followingcesarean section with review and update of the literature concerningthis unusual topic. The disease presented with vaginal urinary leakage,cyclic hematuria and amenorrhea. The fistula was successfully repairedby delayed surgery. Actually, all over the world the prevalence of thedisease is increasing for the frequent use of the cesarean section.Fistulas may develop immediately after a cesarean section, manifest inthe late puerperium or occur after repeated procedures. Spontaneoushealing is reported in 5% of cases. Vesicouterine fistulaspresent with vaginal urinary leakage, cyclic hematuira (menouria),amenorrhea, infertility, and first trimester abortions. The diagnosis isruled out by showing the fistulous track between bladder and uterus aswell as by excluding other more frequent urogenital fistulas. Thedisease treatment options include conservative treatment as well assurgical repair. Rarely, patients refuse any kind of treatment becauseof the benignity of symptoms and prognosis of the disease. Conservativemanagement by bladder catheterization for at least 4–8 weeks isindicated when the fistula is discovered just after delivery since thereis good chance for spontaneous closure of the fistulous track. Hormonalmanagement should be tried in women presenting with Youssef's syndrome.Surgery is the maninstay and definitive treatment of vesicouterinefistulas after cesarean section. Patients scheduled for surgery shouldundergo pretreatment of urinary tract infections. Surgical repair ofvesico-uterine fistulas are performed by different approaches whichinclude the vaginal, transvesical-retroperitoneal and transperitonealaccess which is considered the most effective with the lowest relapserate. Recently, laparoscopy has been proposed as a valid option forrepairing vesicouterine fistulas. The endoscopic treatment may beeffective in treating small vesicouterine fistulas. The pregnancy rateafter repair is 31.25% with a rate of term deliveries of25%. The disease may be prevented by emptying the bladder as wellas by carefully dissecting the lower uterine segment. It is advisablethat after vesicouterine fistula repair delivery should be performed byrepeating a cesarean section since the risk of fistula recurrence.Usually, vesicouterine fistulas are diagnosed postoperatively. As aresult, at least 95% of patients will undergo another operationfor repairing the fistula. In the meantime they are bothered by relatedsymptoms which impair their quality of life. As far as we are concernedintraoperative diagnosis is the gold standard in detecting vesicouterinefistulas for allowing immediate repair. We propose intraoperativesonography by the transvaginal (or transrectal) route for the Foleytransurethral catheter producing bloody urine, for suspecting bladderinjury while dissecting the uterine lower segment and for monitoringpatients who already had had vesicouterine fistula repair. As a resultpatients will avoid the familial and social problems related to thedisease as well another operation. Moreover, ultrasound Dopplerexamination may help in better investigating and understanding thepathophysiology of vesicouterine fistulas.

Bladder Injury During Cesarean Delivery.

Abstract: Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury.

Our experience with genitourinary fistulae.

Abstract: Introduction: Our objective was to analyze the incidence, etiopathology, diagnosis and therapeutic aspects of the genitourinary fistula in an Indian population. Methods:<

Robotic repair of complex vesicouterine fistula with and without hysterectomy.

Abstract: Objective: To present robotic repair of vesicouterine fistulae (VUF) with and without hysterectomy in 3 cases and to discuss the technique with its outcome. Methods: