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to learn a trick is not enough
one needs full understanding of the anatomy and physiology
one has to know exactly what has been lost
only then
with expert surgical skills
one may be able to handle the obstetric fistula
with care
to full satisfaction of
the patient and the surgeon
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DQGLVGLYLGHGLQWRWKHIROORZLQJPDLQO\VPRRWKPXVFOHFRPSRQHQWV pubovesical/posterior pubourethral ligaments (= muscles) pubocervical musculofascia arcus tendineus fasciae = atf cervix cardinal ligaments and broad ligaments sacrouterine ligaments = rectouterinus muscles rectovaginal fascia
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median longitudinal defects GHSHQGLQJXSRQLWVORFDWLRQWKHSRVWHULRUXUHWKUDEODGGHUEDVHPD\KHUQLDWHWKUXWKLV GHIHFWLQWRWKH]HURSUHVVXUHYDJLQDDQGHYHQWXDOO\SURODSVHWRWKHRXWVLGH
central defect WKHFHUYL[XWHUXVZLOOKHUQLDWHWKUXWKLVGHIHFWLQWRWKHYDJLQDDQGWKHQPD\SURODSVH XQRSSRVHGWRWKHRXWVLGHWKUXWKHKHUQLDSURQHRSHQLQJLQWKHSHOYLVIORRUGUDJJLQJWKH DQWHULRUYDJLQDZDOOZLWKLWOLNHLQWXVVXVFHSWLRQ
apical defect WKLVZLOOUHVXOWLQKHUQLDWLRQRIWKHLQWUDSHULWRQHDOFRQWHQWVLQWRWKH]HURSUHVVXUHYDJLQD
posterior defects WKLVZLOOUHVXOWLQKHUQLDWLRQRIWKHUHFWXPLQWRWKH]HURSUHVVXUHYDJLQDHVSHFLDOO\ZKHQ FRPELQHGZLWKSHULQHDOERG\GHIHFWV
lateral defects at atf WKLVZLOOUHVXOWLQORVVRIWRQXVRIWKHHQGRSHOYLFGLDSKUDJPUHVXOWLQJLQDQLQFUHDVHLQWKH FDXGDGFHSKDODGPRYHPHQWVEXWQRWLQKHUQLDWLRQSURODSVHRIDQRUJDQWKUXWKLVGHIHFW
lateral defects of the fascia sheath in between the atf and atlam WKLVZLOOUHVXOWLQPHGLDOGLVSODFHPHQWRIWKHDWIZLWKORVVRIWRQXVDQGK\SHUPRELOLW\RI WKHLQWUDSHOYLFXURJHQLWDOGLDSKUDJPEXWQRWLQKHUQLDWLRQSURODSVHRIDQRUJDQWKUXWKLV GHIHFW
other location GXHWRSHQHWUDWLQJWUDXPDRUIRUFHSVGHOLYHU\RUYDFXXPGHOLYHU\
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circular punched out defects WKHVDPHVL]HDVWKHILVWXODRU VOLJKWO\ ELJJHUWKDQWKHILVWXOD
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