Clinical profile Of patients with Urinary Diversion (Mainz II) For Women With Irreparable Vesico-Vaginal Fistula (VVF) In Eritrea, 2022: A Retrospective Study

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 complications and surgical outcomes by using frequencies and percentages. Results: Urinary diversions were performed on 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 got pregnant after diversion. Eleven (23.4 %) 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 home regions must be developed to overcome barriers to guarantee continuity of care and to decrease the morbidity and mortality of these women.