Fistula-related morbidity decreased by prompt treatment in Sierra Leone

LINTHICUM, MD, April 26, 2009-Extent of fibrosis is the most profound factor in predicting surgical outcomes of genitourinary fistula repair, suggesting that prompt treatment could significantly improve survival. Researchers in Nashville review experiences at two centers in Sierra Leone to assess factors predictive of successful fistula repair. Their findings were presented at the 104th Annual Scientific Meeting of the American Urological Association.

Genitourinary fistulas (abnormal connections between organs or vessels that are normally unconnected) result from prolonged obstructed labor and delivery and are a cause of considerable morbidity in sub-Saharan African countries, such as Sierra Leone. Researchers studied 505 operative repairs from 2004 through 2006. Primary repairs (the patient’s first repair) accounted for 68 percent of the procedures, with 92 percent of those being vesicovaginal fistula alone. Only 56 percent of the women were deemed to have an intact bladder neck or urethra at presentation and 68 percent were diagnosed with moderate to severe fibrosis around the fistula. The average patient age at the time of repair was 29.4 years. The average fistula duration, or time before seeking treatment, was 62 months. Conclusions were derived from statistical analysis of demographics, fistula characteristics, outcomes and surgical complications. On multivariate analysis, the only parameter that correlated with successful repair of the fistula was the extent of fibrosis. Researchers also reported that women with previous pregnancies showed significantly improved outcomes compared to first-time mothers.

“This study highlights a major problem in sub-Saharan African countries that is not well known by the general public or much of the medical community in this country. The fistulas these women experience are often much more complex than what we see in our medical communities. Extent of the fibrosis appears to be a barrier to successful repair,” said Anthony Y. Smith, MD, an AUA spokesman. “Unfortunately, it can be difficult for women in sub-Saharan Africa to obtain timely care. The broader story of these women and the suffering they endure as well as the courage of the unique physicians who care for them is a story that deserves to be told.”

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