Review of Urinary Diversion (Mainz II) for Women with Irreparable Vesico-Vaginal Fistula (VVF) In Eritrea, 2022: A Retrospective Study

Abstract

Introduction: Mainz II urinary diversion procedures are increasingly being performed in the developing world for irreparable obstetric fistulas. Our goal was to review the long-term complications of continent urinary diversion and to evaluate the feasibility of the recommended follow-up protocols in a country with limited resources. Methods: The medical records of patients who underwent urinary diversion or who are under follow-up for irreparable vesico-vaginal fistula (VVF) at National Fistula center (NFC) in Mendefera, Eritrea, between February 2004 and December 2021, were reviewed. Descriptive statistics was used to depict the complications and surgical outcomes. Results: Urinary diversions were performed in 47 patients. The average duration of stay after surgery was 18 days. Metabolic panel and arterial blood gases (ABG) were found only in 26 of the records which showed hyperchloremic acidosis in 22 (84.7%) and decreased kidney function in 8 (30.7%) of the women. Night time incontinence was found in 24 (51.1%) of the cases with 9 (19.1%) experiencing symptomatic renal infections which required admission. Three of the patients developed pouch stones and two patients developed hydronephrosis. Five patients were able to conceive after diversion. Eleven (23.4 %) of the women were lost to follow-up and 10 (21.3 %) died, with majority (70%) of them with unknown cause of death. Conclusion: On top of the long-term complications following diversion, there was substantial loss to follow-up and death after urinary diversion. Therefore, innovative approaches and continuous financial support to ensure patient return or local follow-up in residential regions need to be developed to overcome barriers to guarantee continuity of care and to decrease the morbidity and mortality of these women.