SURGICAL INTERVENTIONS FOR OBSTETRIC FISTULAS IN DEVELOPING COUNTRIES: CHALLENGES IN GYNECOLOGICAL AND UROLOGICAL REHABILITATION

Abstract

Introduction: Obstetric fistulas represent a serious public health problem in developing countries, often resulting from obstructed labor. These conditions can cause not only serious physical harm, such as urinary incontinence and gynecological complications, but also profound social impacts, such as stigmatization and exclusion. Gynecological and urological rehabilitation after surgical interventions is a crucial component in the treatment of these fistulas, but it faces several challenges, including scarcity of resources, lack of professional training, and cultural barriers that hinder access to necessary care. Objective: To explore surgical interventions for obstetric fistulas and the challenges associated with gynecological and urological rehabilitation in developing country settings. Methodology: The research was conducted based on the PRISMA checklist, covering articles published in the last 10 years in the PubMed, Scielo, and Web of Science databases. Five descriptors were used: “obstetric fistula”, “surgical intervention”, “gynecological rehabilitation”, “urological rehabilitation” and “developing countries”. The inclusion criteria consisted of: studies that addressed surgical interventions for obstetric fistulas, articles that analyzed gynecological and urological rehabilitation, and publications in English, Portuguese or Spanish. On the other hand, the exclusion criteria were: articles that did not address the context of developing countries, studies focusing on non-obstetric fistulas and non-original reviews. Results: The results highlighted that, despite advances in surgical techniques, rehabilitation faces significant challenges, such as the need for adequate follow-up programs and cultural resistance to urological interventions. In addition, gaps in the training of health professionals were identified, limiting the effectiveness of treatment. Patients often reported emotional and social difficulties that impacted their recovery. Conclusion: In summary, surgical interventions for obstetric fistulas, although essential, are not sufficient without a comprehensive approach to gynecological and urological rehabilitation. To improve outcomes, it is necessary to invest in professional training and community awareness, promoting a holistic recovery for women affected by these challenging conditions.