Obstetric vesico‐vaginal fistula repair: Should we trim the fistula edges? A randomized prospective study

Shaker, Hassan; Saafan, Ahmed; Yassin, Mohamed; Idrissa, Abdoulaye; Mourad, Sherif

doi:10.1002/nau.20995

Cited by 20 publications

(9 citation statements)

References 11 publications

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“…The included primary studies were conducted in: Ethiopia [31][32][33][34][35]; Nigeria [36][37][38][39][40]; Iraq [41,42]; Pakistan [43,44]; Benin [45]; Rwanda [46]; the USA [47]; Democratic Republic of Congo [48]; Malawi [49]; Burundi [50]; and Tanzania [51]. Five primary studies were performed across multiple countries [52][53][54][55][56].…”

Section: Evidence Map Resultsmentioning

confidence: 99%

Interventions for treating obstetric fistula: An evidence gap map

Johnson

O’Connor²,

Hilton³

et al. 2023

PLOS Glob Public Health

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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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Section: Evidence Map Resultsmentioning

confidence: 99%

Interventions for treating obstetric fistula: An evidence gap map

Johnson

O’Connor²,

Hilton³

et al. 2023

PLOS Glob Public Health

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“…L'unico studio prospettico randomizzato che ha messo a confronto gli outcomes di pazienti sottoposte o meno a recentazione dei margini della fistola è stato condotto su pazienti affette da FVV secondarie a causa ostetrica. Shaker et al (50) hanno reclutato 64 pazienti affette da FVV e le hanno assegnate in modo casuale a due gruppi. Le pazienti di entrambi i gruppi furono trattate tramite un approccio transvaginale con interposizione di flap di Martius ma la recentazione del tramite fistoloso fu eseguita solo in un gruppo.…”

Section: Discussioneunclassified

“…Successi sono stati riportati con l'adozione sia dell'una che dell'altra soluzione. Lo studio prospettico randomizzato pubblicato da Shaker et al a tal proposito (50) non ha messo in luce differenze di risultato in termini di guarigione con l'una o l'altra teenica.…”

Section: Conclusioniunclassified

Repair of post-hysterectomy vesicovaginal fistulae: the state of the art

Giusti

Lisa

2015

Urologia

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In western countries, vesicovaginal fistulae (VVF) are mostly iatrogenic and in the majority of cases are secondary to hysterectomy. The golden standard for the treatment of VVF has remained largely unchanged since 1953 (Couvelaire): good visualization, good dissection, good approximation of the margins, and good urine drainage. However, several aspects are still being debated, including whether or not to pursue conservative repair, the timing for surgical repair, whether to perform excision of the fistula tract, the best type of surgical access, and whether or not to use tissue interposition. We decided to review the state of the art in the treatment of VVF, which are exclusively of a traumatic nature and non-radiated, by performing a bibliography search carried on Pubmed using keywords such as "vesicovaginal fistula". The search focused on recent articles and was largely restricted to the past 10 years.

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“…Repairing recurring fistulas is a surgical challenge because damage to the vagina is more extensive and exposure is more difficult. Shaker et al [10] conducted a study of the vaginal repair of VVFs in 2 groups of patients: VVFs were closed without trimming the edges of the bladder in the first group; the second group underwent trimming of the bladder edges. Some of the patients in the groups were undergoing repair surgery for the first time, whereas others were undergoing repair of recurring fistulas.…”

Section: Discussionmentioning

confidence: 99%