Short period of postoperative bladder catheterization effective for repair of simple urinary fistula

11 January 2018: WHO has today issued a new recommendation on the length of bladder catheterization following surgical repair of a simple obstetric urinary fistula. Currently the length of catheterization is not standard and ranges from 5 to 42 days. The new guidance recommends a 7–10 day period of bladder catheterization to allow complete healing. Longer periods of catheterization can be inconvenient for the woman, her family and care providers as it is associated with more discomfort and inconvenience. It also increases the risk of infection and erosion related to catheterization, requires more intensive nursing care and costs more per patient.

Women at the Hamlin Fistula Hospital, Ethiopia

Hamlin Fistula Hospital, Addis Ababa, Ethiopia

Kate Holt / AusAID

“Leaving women to suffer from fistula, with all the associated health and social consequences when we have the knowledge to treat it, is unacceptable.”
Dr Princess Nothemba Simelela, WHO Assistant Director-General, Family, Women, Children and Adolescents

About obstetric fistula

Obstetric fistula, an abnormal opening between a woman’s genital tract and her urinary tract or rectum. When the mother’s pelvis is too narrow or the baby is too large or presenting in an abnormal position, labour can last several days and often results in the death of the baby and/or the mother. If the mother survives, she could develop a fistula and become unable to control her rectal and/or urinary functions and be constantly soiled and/or wet. Obstetric fistula occurs primarily in sub-Saharan Africa (1.6 cases per 1000 women) and South Asia (1.2 cases per 1000 women). Most can be repaired surgically and catheterization is important to allow tension-free healing of the surgical scar. Until now, the length of the catheterization period has varied significant from 5 to 42 day with decisions often being based on the preferences of individual surgeons rather than on evidence from research.

New WHO recommendation

As part of the World Health Organization’s normative work on supporting evidence-informed policies and practices, the Department of Reproductive Health and Research has produced, as a first step, a new guideline that defines the length of time required for effective catheterization after the surgical repair of simple obstetric urinary fistula as a period of 7–10 days. It is an intervention that can be implemented by any appropriately trained surgeon, including one with less experience, and it has direct health and cost implications in low- and middle-income countries. Shorter periods of postoperative bladder catheterization have been tested in simple cases of obstetric fistula and shown to be effective in allowing complete healing with improved patient comfort and potentially lower risks of catheter-related urinary tract infections. This in turn means less intensive nursing care is required, shorter hospital stays and thus reduced costs for the health system. With shorter stays in hospital it should be possible to increase the number of fistula patients who could receive treatment using the existing facilities.

The primary target audience for this guideline is health-care professionals, particularly fistula surgeons and nurses providing postoperative care to women after surgery for obstetric urinary fistula. The guideline will also be useful to national and local policy-makers, and staff of nongovernmental and other organizations involved in fistula care services.