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Johnson EE, O'Connor N, Hilton P, Pearson F, Goh J, Vale L. Interventions for treating obstetric fistula: An evidence gap map. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001481. [PMID: 36963005 PMCID: PMC10021774 DOI: 10.1371/journal.pgph.0001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023]
Abstract
Obstetric fistula is prevalent in low- and middle-income countries, with between 50,000 and 100,000 new cases each year. The World Health Organization aims to eradicate it by 2030 but a clear idea of the extant evidence is unavailable. This evidence map compiled evidence on treatments for obstetric fistula to identify potential knowledge gaps. The protocol for this work was published on the Open Science Framework (DOI: 10.17605/OSF.IO/H7J35). A survey was developed, piloted and distributed online through organisations with an interest in obstetric fistula and snowballing. Results informed the evidence map framework. Searches were run on MEDLINE, Embase, CENTRAL, Global Index Medicus and ScanMedicine on 16 February 2022 to identify potentially eligible systematic reviews, randomised controlled trials, cohort studies and case-control studies. Forward and backward citation chaining was undertaken on relevant systematic reviews and included studies. Studies were screened, coded and assessed for risk of bias by a single reviewer, with a second checking a proportion. The evidence map results were compared to survey results. Thirty-nine people responded to the survey, half of which were clinicians. Of 9796 records identified, 37 reports of 28 studies were included in the evidence map. Many included studies were at some risk of bias; for observational studies, this was predominantly due to lack of controlling for confounders. Most studies (71%) assessed surgical interventions alone. Reporting on other intervention types was limited. Regarding outcome measures most important to survey respondents, 24 studies reported on cure/improvement in obstetric fistula and 20 on cure/improvement in urinary incontinence. Reporting on quality of life, faecal incontinence and sexual function was limited. There is currently little robust evidence to guide patients and practitioners on the most effective treatment option for obstetric fistula. Further research is required to address evidence gaps identified.
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Affiliation(s)
- Eugenie Evelynne Johnson
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicole O'Connor
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Hilton
- Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona Pearson
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Innovation Observatory, The Catalyst, Newcastle upon Tyne, United Kingdom
| | - Judith Goh
- Griffith University School of Medicine, Queensland, Australia
| | - Luke Vale
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Spinelli MG, Lorusso V, Palmisano F, Morelli M, Dell'Orto PG, Tremolada C, Montanari E. Endoscopic repair of a vesicouterine fistula with the injection of microfragmented autologous adipose tissue (Lipogems ®). Turk J Urol 2020; 46:398-402. [PMID: 32744991 DOI: 10.5152/tud.2020.20170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/18/2020] [Indexed: 11/22/2022]
Abstract
Vesicouterine fistula (VUF) is a rare extra-anatomical communication developing between the uterus or cervix and the urinary bladder, most commonly after an iatrogenic injury during a cesarean section. Patients with VUF may have various clinical presentations, ranging from Youssef's syndrome (vaginal urine leakage, amenorrhea, and menouria) to urinary tract infection and infertility. Quality of life for patients having this pathology is strongly affected owing to the psychological burden. Treatment is surgery based because low success rates have been reported for conservative or minimally invasive approaches. Herein, we present a case of a 35-year-old woman successfully treated by a minimally invasive endoscopic repair procedure with the injection of microfragmented autologous adipose tissue (Lipogems®).
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Affiliation(s)
- Matteo Giulio Spinelli
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vito Lorusso
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,University of Milan, Milan, Italy
| | - Franco Palmisano
- Department of Urology, Andrology Unit, St. Orsola University Hospital, Bologna, Italy
| | - Michele Morelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,University of Milan, Milan, Italy
| | - Paolo Guido Dell'Orto
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Milan, Italy
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Bernard L, Giles A, Fabiano S, Giles S, Hudgins S, Olson A, Shrime MG, Feldman S, Riviello R. Predictors of Obstetric Fistula Repair Outcomes in Lubango, Angola. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1726-1733. [PMID: 30987849 DOI: 10.1016/j.jogc.2019.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Obstetric fistulas have a significant physical and social impact on many women in Angola. The majority of the population of this sub-Saharan African nation does not have access to high-quality obstetric care, and this is associated with a risk of prolonged labour and formation of obstetric fistulas. Fistulas are challenging to correct surgically and may require repeated operations. The objective of the study was to determine predictors of successful obstetric fistula repair. METHODS In this retrospective study, data from all recorded cases of fistula repair performed between July 2011 and December 2016 at the Centro Evangélico de Medicina do Lubango (CEML) hospital located in Lubango, Angola, were reviewed. Analysis of the data was carried out to determine factors affecting the success of fistula repair; parametric and non-parametric tests were used for group comparisons and logistic regression for outcome prediction (Canadian Task Force classification II-2). RESULTS A total of 407 operations were performed on 243 women. Of these, 224 women were diagnosed with a vesicovaginal fistula and 19 with a combined vesicovaginal and rectovaginal fistula. The success rate for the attempted repairs was 42%. On multivariate analysis, the success of first surgery was negatively affected by the difficulty of repair (odds ratio 0.28; P < 0.01). For patients requiring repeat surgery, the odds of success were increased with each subsequent operation (odds ratio 5.32; P < 0.01). CONCLUSION Although fistulas rated as difficult to repair had a higher likelihood of initial failure, successive attempts at repair increased the likelihood of a successful outcome.
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Affiliation(s)
- Laurence Bernard
- Harvard T.H. Chan School of Public Health, Boston, MA; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON.
| | - Andrew Giles
- Harvard T.H. Chan School of Public Health, Boston, MA; Department of Surgery, McMaster University, Hamilton, ON
| | - Sam Fabiano
- Pan-African Academy of Christian Surgeons, Bongolo, Gabon
| | - Stacey Giles
- Centro Evangélico de Medicina do Lubango, Lubango, Angola
| | - Sarah Hudgins
- Centro Evangélico de Medicina do Lubango, Lubango, Angola
| | - Annelise Olson
- Centro Evangélico de Medicina do Lubango, Lubango, Angola
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Center for Surgery and Public Health,(,) Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Widmer M, Tunçalp Ö, Torloni MR, Oladapo OT, Bucagu M, Gülmezoglu AM. Improving care for women with obstetric fistula: new WHO recommendation on duration of bladder catheterisation after the surgical repair of a simple obstetric urinary fistula. BJOG 2018; 125:1502-1503. [PMID: 29729217 PMCID: PMC6220961 DOI: 10.1111/1471-0528.15276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- M Widmer
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ö Tunçalp
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - M R Torloni
- Department of Medicine, Evidence Based Health Care Post-Graduate Program, São Paulo Federal University, São Paulo, SP, Brazil
| | - O T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - M Bucagu
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - A M Gülmezoglu
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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