Urethrocutaneous fistula following VMMC: a case series from March 2013 to October 2019 in ZAZIC\u2019s voluntary medical male circumcision program in Zimbabwe

Vernon Murenje,Tinashe Munyaradzi,Scott Barnhart,Marrianne Holec,Shirish Balachandra,Victor Omollo,John Mandisarisa,Sinokuthemba Xaba,Vuyelwa Chitimbire,Tonderayi Mangwiro,Batsirai Makunike-Chikwinya,Phiona Marongwe,Paidemoyo Gonouya,Joseph Hove,Caryl Feldacker,Mufuta Tshimanga

doi:10.1186/s12894-022-00973-1

Abstract

BackgroundUrethrocutaneous fistula (subsequently, fistula) is a rare adverse event (AE) in voluntary medical male circumcision (VMMC) programs. Global fistula rates of 0.19 and 0.28 per 100,000 VMMCs were reported. Management of fistula can be complex and requires expert skills. We describe seven cases of fistula in our large-scale VMMC program in Zimbabwe. We present fistula rates; provide an overview of initial management, surgical interventions, and patient outcomes; discuss causes; and suggest future prevention efforts.ResultsCase details are presented on fistulas identified between March 2013 and October 2019. Among the seven fistula clients, ages ranged from 10 to 22 years; 6 cases were among boys under 15 years of age. All clients received surgical VMMC by trained providers in an outreach setting. Clients presented with fistulae 2–42 days after VMMC. Secondary infection was identified in 6 of 7 cases. Six cases were managed through surgical repair. The number of repair attempts ranged from 1 to 10. One case healed spontaneously with conservative management. Fistula rates are presented as cases/100,000 VMMCs.ConclusionFistula is an uncommon but severe AE that requires clinical expertise for successful management and repair. High-quality AE surveillance should identify fistula promptly and include consultation with experienced urologists. Strengthening provider surgical skills and establishment of standard protocols for fistula management would aid future prevention efforts in VMMC programs.

Highlights

IntroductionUrethrocutaneous fistula (subsequently, fistula) is a rare adverse event (AE) in voluntary medical male circumcision (VMMC) programs
Urethrocutaneous fistula is a rare adverse event (AE) in voluntary medical male circumcision (VMMC) programs
Since fistulae are rare and there is limited literature of cases in VMMC programs, we present our fistula rate and descriptive case series on seven fistulae that occurred in the ZAZIC-supported VMMC sites from 2013 to 2019

Summary

Introduction

Urethrocutaneous fistula (subsequently, fistula) is a rare adverse event (AE) in voluntary medical male circumcision (VMMC) programs. Global fistula rates of 0.19 and 0.28 per 100,000 VMMCs were reported. We present fistula rates; provide an overview of initial management, surgical interventions, and patient outcomes; discuss causes; and suggest future prevention efforts. Voluntary medical male circumcision (VMMC), an elective procedure which provides partial protection from HIV acquisition [1], poses a risk of adverse events (AEs) like other common surgical procedures [1, 2]. Like other AEs, when fistulae occur, they can lead to costly and time-consuming clinical management; reduced quality of life, possible disfigurement, stigma, and emotional distress for the client; and negative community perception of VMMC [13, 19]

Results

Discussion

Conclusion