Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial

Barone, Mark A.; Widmer, Mariana; Arrowsmith, Steven D.; Ruminjo, Joseph K.; Seuc, Armando; Landry, E; Barry, Thierno Hamidou; Danladi, Dantani; Djangnikpo, L.; Gbawuru-Mansaray, Tagie; Harou, Issoufa; Lewis, Alyona; Muleta, Mulu; Nembunzu, Dolores; Olupot, Robert; Sunday-Adeoye, Ileogben; Wakasiaka, Weston Khisa; Landoulsi, Sihem; Délamou, Alexandre; Were, Lilian; Frajzyngier, Vera; K, Beattie; Gülmezoglu, A. Metin

doi:10.1016/s0140-6736(14)62337-0

Cited by 40 publications

(41 citation statements)

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“…Complications such as urine retention, wound infection and haemorrhage are likely to be linked to quality of services including quality of surgery, implementation of infection prevention measures or postoperative care and duration of catheterization [28]. Overall the occurrence of fistula related postoperative complications was low and the difference between repair hospitals was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice

et al. 2016

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BackgroundThe prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries.The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors.MethodsThis was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes.ResultsOverall, 109 women out of 754 (14.5 %; 95 % CI:11.9–17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8–20.2) were not continent.Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0–3.6), partially (AOR: 2.0; 95 % CI: 1.1–5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9–12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2–4.9).Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5–4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0–13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact.ConclusionAt programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence.

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Section: Discussionmentioning

confidence: 99%

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice

et al. 2016

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“…The cure rate after obstetric VVF surgery is generally above 90% in the hands of skilled fistula surgeons . In the event that there is a fistula repair breakdown, the options are to consider an extended period of bladder catherization or remove the catheter and schedule a repeat surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The findings add an additional management option for those who experience failure of a fistula repair. Two non‐inferiority trials with over 684 patients demonstrated that a shorter duration of bladder catherization after obstetric VVF surgery is not inferior to longer periods of bladder catherization for simple VVFs . While as short a duration of catheterization as possible is advocated, more evidence is needed to guide clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Extended bladder catheterization for women with positive dye tests after obstetric vesicovaginal fistula repair surgery

Chang

Ganesh

Wilkinson

et al. 2020

Intl J Gynecology & Obste

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Objective To determine the success rate and factors that result in a negative dye test after extended bladder catheterization after surgery for obstetric fistula. Methods A retrospective cohort study was carried out on women who underwent obstetric fistula repair in Malawi and had ≥14 days of bladder catherization. Variables such as age, class of fistula, previous repairs, menopausal status, and HIV status were examined for association with successful healing at the end of the catheterization period. Results Fifty‐two patients had a positive dye test after the intended period of catheterization and the catheterization period was extended by 7 days. Of these patients, 29 (55.7%) had a subsequent negative dye test. Older women (mean age 28.4 years) who developed a fistula were more likely to have a negative dye test after extended catheterization, compared to their younger counterparts (mean age 20 years) (P=0.0018). Other variables were not found to be significantly different between the two groups. Conclusion More than half of the patients with a positive dye test had complete closure of the fistula defect after an extension of bladder decompression. It is reasonable to consider an extension of bladder catheterization for 7 days after an initial positive dye test.

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“…A study of obstetric vesicovaginal fistula repair in Africa shows that 7 day catheterization is not inferior to 14 day drainage, illustrating how evidence based research might have a tremendous effect on public health in areas of poorest resources 9 …”

Section: Key Advancesmentioning

confidence: 99%

“…The final article of 2015 that we would like to highlight is the study by Barone et al 9 , which has a direct clinical implication. In their prospective, open-label, controlled trial, the investigators randomized 524 women with simple obstetric vesicovaginal fistulas to 7 days versus 14 days of catheterization following fistula repair.…”

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confidence: 99%

Novel findings continue to challenge researchers and clinicians

Khavari

Boone

2015

Nat Rev Urol

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2015 has seen advances in various bladder conditions. MicroRNAs might become therapeutic targets, the MAPP network characterized central neurological changes in chronic pelvic pain syndrome, and urologists were reminded to consider cognitive effects of long-term anticholinergics use. A study of obstetric vesicovaginal fistula repair shows how evidence-based research might improve public health in poorly resourced countries.

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Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial

Cited by 40 publications

References 20 publications

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice

Extended bladder catheterization for women with positive dye tests after obstetric vesicovaginal fistula repair surgery

Novel findings continue to challenge researchers and clinicians

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