Sling procedures after repair of obstetric vesicovaginal fistula in Niamey, Niger

Abstract

Correction of incontinence is a common and difficult challenge following repair of obstetric vesicovaginal fistula. Compared to published studies on sling procedures, these patients have higher rates of continued incontinence. This is likely due to the frequent loss of a urethral sphincter as well as high prevalence of detrusor overactivity and decreased bladder capacity.

Validation of a culturally compliant voiding platform for urodynamics in African vesicovaginal fistula patients

“…The complexity of factors that have an impact on this "continence gap" has been underestimated because of the lack of adequate diagnostic tools in the low-resource settings where obstetric fistulas are commonly found. Many patients who fail with traditional sling surgery after fistula closure are counseled to consider undergoing urinary diversion to overcome their chronic leakage [10,28], but there are many other techniques that may improve lower urinary tract function in such patients, if more precise urodynamic diagnoses can be made. These techniques could include (but are not limited to) bladder augmentation [29,30], bladder auto-augmentation (partial detrusor myectomy) [31,32], urethral bulking agents [33,34], tensioned midurethral slings with intermittent catheterization [35], or combinations of such techniques paired with medications and targeted physical therapy.…”

“…Moreover, standard treatments for stress incontinence are often unsuccessful in these patients. Ascher-Walsh et al reported a series of 140 women who underwent a sling procedure (fascia lata, rectus fascia, or polypropylene mesh) for presumptive SUI after fistula repair in Niger [10]. They achieved a continence rate of less than 25 % (31 out of 127 patients), which is significantly lower than the typical SUI patients undergoing such surgery in high-income countries.…”

“…They achieved a continence rate of less than 25 % (31 out of 127 patients), which is significantly lower than the typical SUI patients undergoing such surgery in high-income countries. The authors speculated that this might be because of a high prevalence of other undiagnosed urological conditions in these patients [10].…”

Skin flap vaginal augmentation helps prevent and cure post obstetric fistula repair urine leakage: a critical anatomical analysis

“…The problem with obstetric fistulas is not only fistula repair, but ongoing incontinence in up to 55% of patients following successful closure …”

A teamwork approach to obstetric fistula repair training in Uganda

“…However, there are still questions that need to be answered. A study conducted in Niamey, Niger, showed that only 24.4% of women were completely dry after sling procedures had been performed for stress incontinence following fistula repair [9]. Urethral plugs seem to work in selected women, but the occasional plug that ends up in the bladder causes further difficulties.…”