Experts convene in the Addis Ababa Fistula Hospital to address management of ongoing urinary incontinence post vesico-vaginal fistula (VVF) repair
From 5-7 February 2024, FIGO's Fistula Surgery Training Initiative (FSTI) and Hamlin Fistula Ethiopia (HFE) collaboratively held the first Expert Surgical Workshop.
The workshop took place in the Addis Ababa Fistula Hospital with a focus on ongoing urinary incontinence after vesico-vaginal fistula repair.
Recognising the need to address this pressing issue, which causes considerable suffering in approximately 25% of post repair VVF patients, the event included high-level discussions with 16 global experts who shared ideas from a variety of surgical disciplines.
Surgical demonstrations by different experts
took place in theatre each day to share and discuss
innovative new techniques for ongoing incontinence
post VVF repair. These demonstrations also provided the opportunity to identify alternative procedures for such cases, rather than doing a urinary diversion.
The three-day workshop was chaired by expert fistula surgeon and FIGO trainer, Dr Andrew Browning and was held as part of the special events to mark what would have been Dr Catherine Hamlin’s 100th birthday. Dr Hamlin and her late husband Dr Reginald Hamlin dedicated their lives to providing surgical repairs for women with obstetric fistula in Ethiopia. Participants paid tribute to Dr Catherine Hamlin during the workshop, reflecting on her inspiring work and commitment, which transformed the lives of thousands of women, offering them hope and healing.
The exchanges between experts fostered collaboration and mutual learning, laying the groundwork for continued progress in the field of fistula treatment.
All surgical presentations from the Expert Surgical Workshop are now available online.
Expert Surgical Workshop: next steps
Workshop participants are fully committed to strengthen collaborations and advance together to prevent and mitigate the devastating consequences of obstetric fistula, and agreed the following points:
- Use of common language and terminology. The majority voted for the acronym POFRI (Post Obstetric Fistula Repair Incontinence) and this term may be amended slightly in the future.
- Compilation and publication of a position on the current situation of patients with ongoing urinary incontinence post VVF repair (Lead Author/Focal Point: Prof Judith Goh).
- Development of a flowchart for management of patients with ongoing urinary incontinence post VVF repair (Focal Points: Dr Andrew Browning and Lilli Trautvetter)
- Three pilot studies to be conducted, to create an evidence-base for key procedures to address urinary incontinence post VVF repair, as discussed and demonstrated during the workshop including:
- Group 1: Use of bulking agents: Group Lead, Prof Judith Goh.
Members: Drs Melaku Abreha, Michael Breen, Judith Goh, Biniam Sirak, Larry Sirls, James Chapa, Hillary Mabeya - Group 2: Use of platelet-rich plasma (PRP) to improve (urethral) tissue quality and induce coincidental cure: Group Lead, Dr Igor Vaz.
Members: Drs Sunday Lengmang, Hannah Krause, Tigist Tesfaw, Igor Vaz, Jeff Wilkinson, Mohammed Tahir Yahya, Sayeba Akhter, Fekade Ayenachew - Group 3: Prevalence rate of ongoing urinary incontinence post VVF repair (Group Lead: Dr Yeshineh Demrew, Deputy Dr Peter Majinge)
Members: Drs Bitew Abebe, Beede Amare, Ennet Banda, Yeshineh Demrew, Peter Majinge
- Group 1: Use of bulking agents: Group Lead, Prof Judith Goh.
The workshop was considered a great success by the participating experts, and it is anticipated that other associated workshops will take place in the future to expand work on this important topic.