Kees classification of obstetric and other urine fistulas as based on quantitative and qualitative pelvis tissue loss and on the continence mechanism

Objective: A classification of the obstetric and other urine fistulas is presented based on pelvis tissue loss and involvement of the anatomic continence mechanism: Materials and Methods: Kees I fistulas: not involving the continence mechanism; Kees IIAa fistulas: involving the continence mechanism...

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Bibliographic Details
Published in:Pelviperineology 2021-06, Vol.40 (2), p.83-88
Main Author: WAALDIJK, KEES
Format: Article
Language:English
Subjects:
Bladder
Bones
Cartilage
Cervix
Cesarean section
Classification
Fistula
Hysterectomy
Obstetrics
Urine
Uterus
Vagina
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Summary:Objective: A classification of the obstetric and other urine fistulas is presented based on pelvis tissue loss and involvement of the anatomic continence mechanism: Materials and Methods: Kees I fistulas: not involving the continence mechanism; Kees IIAa fistulas: involving the continence mechanism without (sub)total urethra involvement and without a circumferential defect; Kees IIAb fistulas: involving the continence mechanism without (sub)total urethra involvement and with a circumferential defect; Kees IIBa fistulas: involving the continence mechanism with (sub)total urethra involvement and without a circumferential defect; Kees IIBb fistulas: involving the continence mechanism with (sub)total urethra involvement and with a circumferential defect and miscellaneous; Kees III fistulas: like ureter fistulas; Results: The characteristics of each class are described and why they differ from each other by qualitative and quantitative pelvis tissue loss. There is a fluid transition from Kees I into Kees IIAa and from Kees IIAa into Kees IIBa and from Kees IIAa into Kees IIAb and from Kees IIAb into Kees IIBb fistulas. Each fistula class needs to undergo a specific operation:from incision to dissection to repair of pelvis structures, in addition to fistula closure. This is to reconstruct the functional pelvis anatomy. Conclusion: With this classification it is possible to plan and execute the fistula repair according to the principles of reconstructive surgery and to compare the operation techniques and results in a scientific way. However, these are only guidelines as each fistula constitutes its own unique entity and needs its own customized approach.
ISSN:1973-4905
1973-4913
DOI:10.34057/PPj.2021.40.02.004