Panzi score as a parsimonious indicator of urogenital fistula severity derived from Goh and Waaldijk classifications

Mukwege, Denis; Peters, Lisa; Amisi, Christine; Mukwege, Alain; Smith, Abigail R.; Miller, Janis M.

doi:10.1002/ijgo.12514

Cited by 10 publications

(12 citation statements)

References 18 publications

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“…Prolonged labor is the primary risk factor of OF. The current study with an average of labor duration over than two days (49.8 hours) confirms the results of previous reports from Africa [ 6 , 12 – 14 ]. The logistical difficulty to access to emergency obstetric care is a main trouble for women living in rural area.…”

Section: Discussionsupporting

confidence: 92%

“…So, developing countries have initiated strategies to facilitate accessibility to caesarean section. But most of these caesarean sections often cause an additional risk to have an UGF because they are performed in ischemic tissues after a prolonged labor or when the fetus death in utero is recorded for several days [ 6 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The size is determined by the ischemic zone, from which is removed the pressure ulcer giving way to the UGF. This ischemic area will cause tissue changes leading to fibrosis [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The predictive factors of treatment's failure are subject to controversies. Some authors reported only clinical and therapeutic implications while others pointed out the importance of the psychosocial status of the patient [ 7 , 14 , 20 ]. In our study, factors which can be regarded as predictive factors of failure are sclerosis, the loss of tissue, and the urethral destruction.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study

Kaboré

Nama

Ouédraogo³

et al. 2021

Advances in Urology

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Objective. To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years’ period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. Results. 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05–3.1]), low level of education (OR = 5.4; CI = [2.3–12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7–6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1–4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1–20.5]). Conclusion. OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…The size is determined by the ischemic zone, from which is removed the pressure ulcer giving way to the UGF. This ischemic area will cause tissue changes leading to fibrosis [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study

Kaboré

Nama

Ouédraogo³

et al. 2021

Advances in Urology

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“…Fistula diagnosis is confirmed with pelvic examination and a methylene blue dye test. The MSO team utilizes the Panzi score to categorize severity of cases . Simple fistula cases (score of 0) are scheduled for surgery; complex cases (score 1, 2, or 3) or those with co‐morbidities, such as malnutrition, HIV, or active infection are referred to Panzi Hospital for treatment.…”

Section: Methodsmentioning

confidence: 99%

The mobile surgical outreach program for management of patients with genital fistula in the Democratic Republic of Congo

Maroyi

Keyser²,

Hosterman³

et al. 2020

Intl J Gynecology & Obste

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Objective: To describe components of the mobile surgical outreach (MSO) program as a model of care delivery for women with genital fistula; present program results; and discuss operational strengths and challenges. Methods: A retrospective observational study of routinely collected health data from women treated via the MSO program (2013-2018). The program was developed at Panzi Hospital in the Democratic Republic of Congo to meet the needs of women with fistula living in remote provinces, where travel is prohibited. It includes healthcare delivery, medico-surgical training, and community sensitization components. Results: The MSO team cared for 1517 women at 41 clinic sites across 18 provinces over the study period. Average age at presentation was 31 years (range, 1-81 years). Most women (n=1359, 89.6%) presented with vesicovaginal fistula. Most surgeries were successful, and few women reported residual incontinence postoperatively. Local teams were receptive and engaged in clinical skills training and public health education efforts. Conclusion:The MSO program addresses the backlog of patients awaiting fistula surgery and provides a template for a national strategic plan to treat and ultimately end fistula in DRC. It offers a patient-centered approach that brings medico-surgical care and psychosocial support to women with fistula in their own communities.

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Obstetric fistula scoring tool for surgical trainees

Pope

Mernoff

Chalamanda

et al. 2021

Intl J Gynecology & Obste

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Obstetric fistula is a condition that continues to mar the quality of the lives of approximately 2 million women worldwide. 1 The United Nations has issued a call to end obstetric fistula by 2030. Currently, only a fraction of women who need surgical repair receive it and there is little follow up on surgical outcomes. 2 It is of utmost importance to train more high-quality surgeons, as the first attempted repair is the best chance at lasting success.One of the most difficult aspects of surgical training is identifying which cases are appropriate for what level of expertise. Bengtson et al. 3 looked for prediction of incontinence after surgery using Goh's classification. Using a scoring algorithm based on clinical and demographic characteristics, they found age over 50 years, length of time with a fistula more than 20 years, previous surgical attempts, advanced Goh classification relative to the urethra, moderate to severe scarring, circumferential fistula, and urethral length of 1.5 cm or less were all highly predictive of residual incontinence within 120 days of surgery. The authors found that a risk score of 20 or more had a sensitivity of 82% and specificity of 63% in predicting residual incontinence. The positive predictive value for this cut-point was 43% and negative predictive value was 91%, meaning that the risk score

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Panzi score as a parsimonious indicator of urogenital fistula severity derived from Goh and Waaldijk classifications

Cited by 10 publications

References 18 publications

Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study

Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study

The mobile surgical outreach program for management of patients with genital fistula in the Democratic Republic of Congo

Obstetric fistula scoring tool for surgical trainees

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