Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a Glance
BACKGROUND: Obstructed labor leading to a vesicovaginal fistula remains a devastating outcome of childbirth in low-resource countries. Women with an irreparable vesicovaginal fistula may be candidates for a urinary diversion, such as the Mainz II modified ureterosigmoidostomy procedure. Previous rev...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | AJOG Global Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666577824000443 |
| _version_ | 1797208781642268672 |
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| author | Tulsi D. Patel, MD Ennet B. Chipungu, MBBS Jennifer M. Draganchuk, MD Chisomo Chalamanda, DCM Jeffrey P. Wilkinson, MD |
| author_facet | Tulsi D. Patel, MD Ennet B. Chipungu, MBBS Jennifer M. Draganchuk, MD Chisomo Chalamanda, DCM Jeffrey P. Wilkinson, MD |
| author_sort | Tulsi D. Patel, MD |
| collection | DOAJ |
| description | BACKGROUND: Obstructed labor leading to a vesicovaginal fistula remains a devastating outcome of childbirth in low-resource countries. Women with an irreparable vesicovaginal fistula may be candidates for a urinary diversion, such as the Mainz II modified ureterosigmoidostomy procedure. Previous reviews state that the procedure should be considered in low-resource countries. However, given the limited duration of postoperative follow-up, these studies do not adequately represent the long-term morbidity and mortality that is likely associated with this procedure. We present data that strongly support avoiding the procedure in low-resource countries. OBJECTIVE: This study aimed to evaluate the postoperative status of the patient (dead, alive, lost to follow-up) and time to death following the Mainz II procedure. STUDY DESIGN: This is a case series including 21 patients who underwent a Mainz II urinary diversion from April 2013 to June 2015 for management of irreparable vesicovaginal fistula at the Fistula Care Centre in Lilongwe, Malawi. Patients were seen postoperatively at 3, 6, 9, and 12 months, followed by every 6 to 12 months thereafter. Descriptive statistics were performed to summarize the data. RESULTS: During the postoperative period, 8 (38.1%; 8/21) patients died, 5 (23.8%; 5/21) were lost to follow-up, and 8 (38.1%; 8/21) are currently alive and followed up at the Fistula Care Centre. We strongly suspect that 7 of the 8 deaths were related to the procedure given that the patients had illnesses that exacerbated the metabolic consequences of the procedure. The eighth patient died after being attacked by robbers. Unfortunately, the exact cause of death could not be determined for these patients. Given that most of the suspected illnesses would be treatable in an otherwise healthy patient, even in this low-resource setting, we surmised that the metabolic compromise from the Mainz II procedure likely contributed to their untimely death. The average time from procedure to death was 58 months, with the earliest death at 10 months and the most recent at 7 years after the procedure. CONCLUSION: The Mainz II procedure is an option for patients with irreparable fistula. However, it should likely not be performed in low-resource countries given the long-term complications that often cannot be adequately addressed in these settings, leading to significant morbidity and mortality. |
| first_indexed | 2024-04-24T09:44:16Z |
| format | Article |
| id | doaj.art-56d54fd5cbb34a8bb2ee737a5ce916c7 |
| institution | Directory Open Access Journal |
| issn | 2666-5778 |
| language | English |
| last_indexed | 2024-04-24T09:44:16Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJOG Global Reports |
| spelling | doaj.art-56d54fd5cbb34a8bb2ee737a5ce916c72024-04-15T04:05:46ZengElsevierAJOG Global Reports2666-57782024-05-0142100350Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a GlanceTulsi D. Patel, MD0Ennet B. Chipungu, MBBS1Jennifer M. Draganchuk, MD2Chisomo Chalamanda, DCM3Jeffrey P. Wilkinson, MD4Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Patel, Draganchuk, and Wilkinson)Freedom from Fistula Foundation, Fistula Care Centre, Lilongwe, Malawi (Drs Chipungu and Chalamanda)Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Patel, Draganchuk, and Wilkinson)Freedom from Fistula Foundation, Fistula Care Centre, Lilongwe, Malawi (Drs Chipungu and Chalamanda)Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Patel, Draganchuk, and Wilkinson); Corresponding author: Jeffrey P. Wilkinson, MD.BACKGROUND: Obstructed labor leading to a vesicovaginal fistula remains a devastating outcome of childbirth in low-resource countries. Women with an irreparable vesicovaginal fistula may be candidates for a urinary diversion, such as the Mainz II modified ureterosigmoidostomy procedure. Previous reviews state that the procedure should be considered in low-resource countries. However, given the limited duration of postoperative follow-up, these studies do not adequately represent the long-term morbidity and mortality that is likely associated with this procedure. We present data that strongly support avoiding the procedure in low-resource countries. OBJECTIVE: This study aimed to evaluate the postoperative status of the patient (dead, alive, lost to follow-up) and time to death following the Mainz II procedure. STUDY DESIGN: This is a case series including 21 patients who underwent a Mainz II urinary diversion from April 2013 to June 2015 for management of irreparable vesicovaginal fistula at the Fistula Care Centre in Lilongwe, Malawi. Patients were seen postoperatively at 3, 6, 9, and 12 months, followed by every 6 to 12 months thereafter. Descriptive statistics were performed to summarize the data. RESULTS: During the postoperative period, 8 (38.1%; 8/21) patients died, 5 (23.8%; 5/21) were lost to follow-up, and 8 (38.1%; 8/21) are currently alive and followed up at the Fistula Care Centre. We strongly suspect that 7 of the 8 deaths were related to the procedure given that the patients had illnesses that exacerbated the metabolic consequences of the procedure. The eighth patient died after being attacked by robbers. Unfortunately, the exact cause of death could not be determined for these patients. Given that most of the suspected illnesses would be treatable in an otherwise healthy patient, even in this low-resource setting, we surmised that the metabolic compromise from the Mainz II procedure likely contributed to their untimely death. The average time from procedure to death was 58 months, with the earliest death at 10 months and the most recent at 7 years after the procedure. CONCLUSION: The Mainz II procedure is an option for patients with irreparable fistula. However, it should likely not be performed in low-resource countries given the long-term complications that often cannot be adequately addressed in these settings, leading to significant morbidity and mortality.http://www.sciencedirect.com/science/article/pii/S2666577824000443global women's healthlow-resource countriesobstetrical fistulaobstetrics and gynecologyobstructed laborsurgical outcomes |
| spellingShingle | Tulsi D. Patel, MD Ennet B. Chipungu, MBBS Jennifer M. Draganchuk, MD Chisomo Chalamanda, DCM Jeffrey P. Wilkinson, MD Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a Glance AJOG Global Reports global women's health low-resource countries obstetrical fistula obstetrics and gynecology obstructed labor surgical outcomes |
| title | Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a Glance |
| title_full | Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a Glance |
| title_fullStr | Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a Glance |
| title_full_unstemmed | Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a Glance |
| title_short | Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in MalawiAJOG MFM at a Glance |
| title_sort | mainz ii urinary diversion in low resource settings patient outcomes in women with irreparable fistula in malawiajog mfm at a glance |
| topic | global women's health low-resource countries obstetrical fistula obstetrics and gynecology obstructed labor surgical outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2666577824000443 |
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