Genitourinary Fistula Experience in Sierra Leone: Review of 505 Cases

Lewis, Alyona; Kaufman, Melissa R.; Wolter, Christopher E.; Phillips, Sharon; Maggi, Darius; Condry, Leesa; Dmochowski, Roger R.; Smith, Joseph A.

doi:10.1016/j.juro.2008.11.106

Cited by 31 publications

(27 citation statements)

References 15 publications

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“…This is probably because large fistula or multiple fistulae make it difficult to mobilize local tissue and achieve a tension free repair because of insufficient bladder tissue. Besides, our study provided further evidence on negative influence of perifistula fibrosis on fistula prognosis, consistent with the result of the other literatures [17,23] . It was plausible that scar tissue may result in limited tissue mobilization for a tension free repair.…”

Section: Discussionsupporting

confidence: 92%

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

Zhou

Yang²,

Luo³

et al. 2016

Urol Int

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Introduction: We aimed to report the outcomes of patients undergoing vesicovaginal fistula (VVF) repair to identify prognostic factors. Materials and Methods: Patients who underwent VVF repair between January 2009 and October 2015 were reviewed. Primary outcome was fistula closure at 3 months. Results: A total of 123 patients and 139 procedures of VVF repair were reviewed. The overall success rate was 85.6%. There were no significant differences in age (p = 0.476), etiology (p = 0.900), fistula duration (p = 0.491) and number of repairs (p = 0.509) between success and fail group. Moderate or severe perifistula fibrosis and multiple fistula were associated with failure in repair of fistula (70.8 vs. 93.4%, p < 0.001; 62.5 vs. 88.6%, p = 0.005). No difference was seen in success rate of vaginal and abdominal approaches (86.0 vs. 85.0%, p = 0.800). Logistic regression analysis identified fistula number (p = 0.003) and perifistula fibrosis (p = 0.002) as 2 independent prognostic factors. Medium/large fistulas were 3.2 times more likely to fail in repair than small fistulas (OR 3.2, 95% CI 0.95-10.6, p = 0.061). Conclusions: Fistula number and perifistula fibrosis were 2 independent prognostic factors for fistula repair. Unsuccessful closure was more likely in medium/large VVF.

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Section: Discussionsupporting

confidence: 92%

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

Zhou

Yang²,

Luo³

et al. 2016

Urol Int

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“…Juxtacervical fistula repairs appear to have better outcomes than the other fistula locations and secondary repairs are less likely to be successful as noted by multivariable logistic regression analysis. These results corroborate other reports [1, 10] and in the case of location of fistulae, may reflect the potential ability in general to more fully mobilize and obtain tension-free closures with juxtacervical repairs as compared to juxtaurethral repairs [7, 8]. Further, secondary repairs are inherently more difficult from increased scarring associated from previous surgery [1, 8, 10].…”

Section: Introductionsupporting

confidence: 89%

“…A large fistula series from Sierra Leone reported a 92% and 63% success with midvaginal and juxtaurethral fistulae respectively, with a 73% versus 27% success rate in primary and secondary repairs respectively. Few other studies have included patients undergoing second repairs in their outcome analysis [8]. …”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Post-Operative Short-Term Outcomes of Vesicovaginal Fistula Repairs in a Community Hospital in Liberia

Munoz

Bowling

Gerten

et al. 2011

British Journal of Medical and Surgical Urology

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Objectives To assess factors influencing short-term outcomes of vesicovaginal fistula (VVF) repairs in community-dwelling women of Liberia, Africa. Methods Forty patients who underwent VVF repairs were analyzed. Primary outcome was continence status at 14 days post repair. Factors influencing continence status were characterized. Results The mean duration of leakage was 9.6 ± 8.3 years, (3 months–28 years). Thirteen (33%) had previous repairs, and 6 (15%) had multiple fistula sites. Twenty-eight (70%) were continent at catheter removal. First time repairs had a higher continence rate compared to women with previous repairs, 78% and 54% respectively (p= 0.15). Seven (47%) juxtaurethral repairs were considered failures, while only one (9%) juxtacervical fistulas remained incontinent (p= 0.069). Controlling for duration of leakage, women with previous repairs were significantly less likely to be continent (p = 0.04; adjusted OR = 0.07; 95% CI: 0.005, 0.83). Conclusions Patients with previous VVF repairs and juxtaurethral fistulae experience lower success rates; surgery remains an effective treatment for many VVF patients.

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“…There are ongoing governmental and charitable efforts to identify and refer fistula patients for surgery [10]. Surgical repair has up to a 90 % success rate in closing the fistula [11, 12]. However, even when the fistula is closed, up to one-third of women continue to experience incontinence due to weakened or damaged pelvic floor musculature [13].…”

Section: Introductionmentioning

confidence: 99%

Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting

Wilson

Sikkema

Watt

et al. 2016

Matern Child Health J

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Objectives Obstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients' homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants (N = 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.

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Genitourinary Fistula Experience in Sierra Leone: Review of 505 Cases

Cited by 31 publications

References 15 publications

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

Factors Influencing Post-Operative Short-Term Outcomes of Vesicovaginal Fistula Repairs in a Community Hospital in Liberia

Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting

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