Continuous Urinary Incontinence Research Articles

Efficacy of urine loss ratio for prognosis of urinary continence after radical prostatectomy: A retrospective cohort study in a single Japanese institution.

The usefulness of the urine loss ratio in the early postoperative period for prognosis of long-term urinary continence after radical prostatectomy has not been fully determined. All patients who underwent radical prostatectomy for prostate cancer at our institution between November 2015 and March 2021 were retrospectively included. We investigated the rate of continence achievement 1 year after surgery, as well as the associated risk factors for reduced continence achievement, classified by every 10% of the urine loss ratio. Of the 100 patients with available urine loss ratio data, 66 achieved urinary continence. Ninety-three percent of patients with urine loss ratios of ≤10%, 40%-75% of patients with urine loss ratios of 11%-80%, and 20%-36% of patients with urine loss ratios of >80%, achieved continence. The logistic regression analysis showed that the urine loss ratio severity, body mass index (BMI) of >25 kg/m², and smoking history were unfavorable to achieve urinary continence. A BMI of ≤25 kg/m² was favorable for urinary continence achievement, but only up to an 80% urine loss ratio. Nonsmokers achieved continence well, even with a urine loss ratio of >80%. Classifying patients into three groups based on their urine loss ratios is potentially useful for urinary continence prognosis. Smoking and obesity were risk factors for continued urinary incontinence, although the prognostic accuracy was expected to improve when considering the severity of the urine loss ratio.

Cytological Evaluation of Urinary Samples among Vesicovaginal Fistula Patients in National Obstetrics Fistula Centre, Southeastern Nigeria

Vesicovaginal fistula (VVF) is a non-physiological epithelial fistulous tract between the bladder and the vagina, resulting in continuous urinary incontinence. VVF occurs most commonly after obstetrical and gynecological injury. This study is a descriptive cross-sectional study designed to carry out cytological evaluation of urine samples of vesicovaginal fistula patients in National Obstetrics Fistula Centre, Southeastern Nigeria. The voided and catheterized urine samples collected were stained using Papanicolaou and Diff-Quick staining techniques. A total number of 123 patients were involved in this study. The mean age of the patients was 36.66 (± 6.21) years. The patients were grouped according to age into 4 groups: 1 (0.8%) was ≤ 24 years, 59 (48.0%) were 25 to 34 years, 43 (35.0%) were 35 to 44 years and 20 (16.2%) were ≥ 45 years of age. The parity status of these cases was grand multipara 29 (23.6%), multipara 32 (37.4%), primipara 46 (37.4%) and nullipara 16 (13.0%). Majority of the patients 111 (90.2%) were from rural areas, 8 (6.5%) from urban areas and 4 (3.3%) were from semi-urban areas. According to marital status, 91 (74.0%) were married, 16 (13.0%) were widowed, 5 (4.1%) were single and 11 (8.9%) were divorced. According to the period the patients had lived with fistula, majority of the patients 94 (76.4%) had lived less than one year with this problem, while 29 (23.6%) had suffered from VVF for 1-5 years. Cytological evaluation of the urine smears showed that a total of 92 (74.8%) urine samples had normal findings. The rest of the 31 (25.2%) urine samples showed a variety of findings. Out of these 31 samples, 16 (51.6%) showed inflammatory aggregates suggestive of urinary tract inflammation, 3 (9.7%) showed decoy cells suggestive of Polyoma virus infection, 7 (22.6%) cases showed perinuclei halo suggestive of Trichomonas vaginalis infection, 3 (9.7%) showed oval fat bodies suggestive of possible nephrotic syndrome, 8(25.8%) cases showed koilocytes, indicative of Human papilloma virus infections. Cases that showed presence of haematuria were 7 (22.6%). There was no case of tumor cells detected in all the urine samples examined. From the outcome of this study, it is important to take special note of the presence of the viral carcinogens: Polyoma virus and Human papilloma virus, since in theory and as reported in few case reports, malignancy of the urinary tract can lead to formation of vesicovaginal fistula.

Bilateral ureteral ectopia with duplex collecting system and hypoplastic bladder: a rare variant

BackgroundBilateral single system ectopic ureter is a rare congenital anomaly, but bilateral ureteral ectopia with duplex collecting system with bladder hypoplasia is even rarer. Urinary incontinence in such cases is dealt with various reconstructive procedures.Case presentationA 20-year-old female presented with continuous urinary incontinence without normal voiding since birth. Imaging revealed bilateral duplex collecting system with ectopic ureter draining into the vestibule, and hypoplastic bladder. The patient was managed with Mainz-II pouch creation with serous lined extramural ureteral reimplantation technique with complete resolution of incontinence.ConclusionOur article highlights the challenges in surgical planning, treatment and the patient perspectives for this rare congenital malformation presenting with incontinence.

NURSING CARE OF CONTINUOUS URINARY INCONTINENCE IN THE ELDERLY POST-ISCHEMIC STROKE A CASE REPORT

Introduction : Continuous urinary incontinence is the continued and uncontrolled passing of urine without distension and a feeling of fullness in the bladder due to neurological dysfunction. This condition is often found in the elderly post-ischemic stroke. The study aimed to describe nursing care of continuous urinary incontinence in the elderly post-ischemic stroke in Lamongan. Methods : This study used a case study approach (case report) on a participant through the nursing process approach. The sample in this study is one patient, an elderly post-ischemic stroke. This research was conducted in 2021 in Lamongan with three visits to patients' homes for seven days. Data collection techniques include interviews, observation, and physical examination. This research instrument uses the gerontic nursing care format and sandvik severity index. Results : Continuous urinary incontinence nursing care with the main intervention for urinary incontinence treatment (I.04163) and the supporting intervention is pelvic muscle exercises (I.07215) can be applied to elderly post-ischemic stroke according to the expected outcomes. The continuous urinary incontinence has a partially resolved on the third home visit. The client can hold urine several times when the bladder feels full, reduced the frequency of night urination, and rarely wakes up because of wet diapers. Sandvik Severity Index shows a value of 4 (moderate incontinence). Conclusions: Improving nursing care need for collaboration between patients, families, and health workers in performing pelvic muscle exercises independently, continuously, and regularly to increase the strength of the detrusor-sphincter muscles and showed improvement in urinary continence.

Complications of the suburethral sling in the form of Mini Vaginal Tape (MVT): A case report.

Synthetic sub-urethral sling has become the most widely used technique for the surgical management of stress urinary incontinence. Despite a higher success rate, complications like migration, encrustation, and stone formation have been reported by a mid-urethral sling (MUS). Among mid-urethral sling procedures, mini vaginal tape (MVT) is very popular. As periurethral stone formation and urethrovaginal fistula are very uncommon after MVT, case report on this issue is sparse. The current case report features a 55-year female presented with lower abdominal pain and continuous urinary incontinence, 10 years after the MVT. She was diagnosed as a case of periurethral stone with urinary incontinence due to urethro-vaginal fistula. Our surgical team successfully removed the stone formed by the encrustation of the displaced tape and repaired the fistula. Following the MVT, a high degree of suspicion and long-term follow-up is mandatory for the diagnosis and management of these rare complications.

Traumatic Urethrovaginal Fistula from Female Genital Mutilation Presenting as Bladder Outlet Obstruction: A Rare Case Report

Urethrovaginal fistula is an abnormal communication between urethra and vagina by an epithelialized tract. In girls the cause can be congenital or post traumatic. Female genital mutilation may be associated with urethrovaginal fistula and the predominant presentation is that of continuous urinary incontinence. Presentation with bladder outlet obstruction and inability to pass urine is rare. We report a 12-year old girl with traumatic urethro-vaginal fistula post female genital mutilation who presented with inability to pass urine and bladder outlet obstruction.

Ectopic ureter: Case report

Urinary system congenital anomalies are more common than other systems. The double collecting system is caused by the emergence of two separate ureter buds from a single Wolff duct or incomplete fusion of the ureter bud with the upper and lower pole parts of the kidney. The opening of the ureter orifice to the bladder neck or to a point other than trigon is called an ectopic ureter. In this case, we report the findings of a 6-year-old girl who complained of continuous urinary incontinence. Our patient had a left-sided double collector system and the ectopic ureter draining the upper pole was opened infra sphincteric to the vaginal vestibule. In the treatment of the ectopic ureter. ın our case the renal upper pole of the ectopic localized ureter was functional. End-to-side uretero-ureterostomy was performed. Ectopic ureter should be considered in the differential diagnosis of girls with continuous urinary incontinence.

An Unusual Cause of Female Urinary Incontinence Following Obstetric Trauma

Urethral coitus is a rarely reported cause of female urinary incontinence and has been most commonly described in women with vaginal and hymenal anomalies. Herein, we report a 41-year-old woman with a complex obstetric history, who presented with continuous urinary incontinence. On evaluation, she was found to have an abnormally dilated urethral orifice and vaginal stenosis suggestive of chronic urethral coitus. She underwent a reduction urethroplasty with autologous sling insertion and a vaginoplasty using vaginal flaps. This case highlights the fact that urethral coitus, though rare, should be considered as a cause of urinary incontinence in women with history of obstetric vaginal trauma.

Continence after BNR in the complete repair of bladder exstrophy (CPRE): A single institution expanded experience

Several surgical methods have been used for primary repair of bladder exstrophy in the newborn. Complete primary repair of exstrophy (CPRE) aims to prevent the need for surgeries beyond the newborn period. Due to the rarity of bladder exstrophy, it has proven difficult in the past to analyze whether use of this method of closure truly does confer acceptable continence outcomes and hence minimizes the requirement for additional surgeries later in life. To describe the continence outcomes of CPRE patients who went on to receive bladder neck reconstruction (BNR), and secondarily, to compare clinical features between those patients who were able to receive undergo a BNR compared to those who were not. An IRB approved database of 1330 exstrophy-epispadias patients was used to identify referred patients after successful CPRE for management of continued urinary incontinence. Urinary continence outcomes were assessed in those who underwent modified Young Dees Leadbetter BNR following CPRE. Sixty-one patients were referred for treatment after successful CPRE between 1996 and 2016. None developed continence or a dry interval after primary closure. Of these, forty-two (68.9%) underwent BNR by a single surgeon at a mean age of 5.8 years (range 5-8.4). The mean bladder capacity at BNR was 147mL (range 102-210mL). Twenty-five (59.5%) achieved day and night continence, 7 (16.7%) gained daytime continence with nocturnal leakage, and 10 (23.8%) remain totally incontinent. Mean follow-up after BNR was 5.9 years. Combined CPRE and pelvic osteotomy were performed in 100% of patients who were continent and 75% of those who were daytime dry. No continent patient had a ureteral reimplantation before BNR, whereas 4 patients with daytime continence and nocturnal leakage and 7 patients who remained continuously incontinent did. This is the largest known series of BNRs in exstrophy patients closed by CPRE. Previous smaller studies have demonstrated mild to moderate success rates of BNR after CPRE, with many patients still requiring additional continence surgeries. The present study found similar results, with additional indication that successful primary closure and use of pelvic osteotomies may correlate with enhanced continence. This study includes outcomes from a single surgeon, with a maximum length of follow up of 13 years. CPRE alone often does not render patients continent of urine, based on the authors' referral population. However, following BNR continence rates in this subgroup were found to reach 76%. Surgeons who treat this population should keep these factors in mind when planning continence surgeries.

Impact of obesity on male urethral sling outcomes.

Background:The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use.Methods:A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed.Results:A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min (p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily (p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement.Conclusion:Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.

Selective renal segmental artery embolization for hydronephrotic upper renal moiety: simple alternative to standard surgical resection.

Duplex kidney with an ectopic upper moiety ureter usually presents with urinary incontinence in young females. If the ectopic ureter belongs to a non-functioning moiety, it is treated with surgical resection of the moiety. Renal artery embolization has been used in patients with a poorly functioning kidney for various indications. In the present report, a 30-year old lady presented with continuous urinary incontinence with normal voids in between. On evaluation, she was found to have duplex left kidney with poorly functioning upper moiety associated with an ectopic ureter opening into the vagina. She underwent successful upper segmental renal artery embolization with no postoperative complications and uneventful recovery. Hence, renal artery embolization is a minimally invasive and well tolerated alternative to surgical partial or heminephrectomy for a non-functioning duplex renal moiety.

Henry van Roonhuyse and the first repair of a vesico-vaginal fistula (~1676).

Obstetric vesico-vaginal fistula is a traumatic complication of prolonged obstructed labor in which pressure necrosis from the impacted fetal head destroys portions of the vesico-vaginal septum, resulting in continuous and uncontrollable urinary incontinence. Ancient evidence suggests that fistula cases have probably been occurring since the development of rotational delivery mechanics in anatomically modern humans hundreds of thousands of years ago. It is likely that attempts to repair such injuries also have a long history. The early history of vesico-vaginal fistula surgery was investigated to determine the earliest credible report of successful cure of this condition. Historical review of vesico-vaginal fistula surgery was undertaken, focusing on the work of Henry Van Roonhuyse, a seventeenth century Dutch surgeon living in Amsterdam. Van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) was reviewed in detail and is described in this article. His technique for vesico-vaginal fistula repair included six essential steps that are still recognizable today: (1) use of the lithotomy position; (2) exposure of the fistula with a speculum; (3) sharp paring of the fistula edge prior to attempted closure; (4) careful approximation of the denuded edges of the fistula; (5) dressing of the wound with absorbent vaginal packing; (6) immobilization of the patient in bed until the repair has healed. Henry Van Roonhuyse is the most credible candidate presently known for having successfully repaired a vesico-vaginal fistula in the pre-modern era.

Time to recovery from obstetric fistula and determinants in Gondar university teaching and referral hospital, northwest Ethiopia

BackgroundObstetric fistula is an abnormal connection between the vagina and rectum and/or bladder, which leads to continuous urinary or fecal incontinence. It is a serious problem in the world poorest countries, where most mothers give birth without any medical care. In most cases obstetric fistula is preventable and can be treated successfully, if it is carried out by a competent surgeon with a good follow-up of postoperative care. However, there remains to explore more on the duration of obstetric fistula recovery and determinant factors. The aim of this study was to estimate the average recovery time of obstetric fistula and to identify its determinants in Gondar University teaching and referral hospital, northwest Ethiopia.MethodA retrospective follow up study was conducted at Gondar University teaching and referral hospital. A total of 612 fistula cases were included in the study and simple random sampling technique was applied to select the study subjects. Kaplan-Meier and log rank test were computed to explore the data. Weibull regression survival model with univariate frailty was done to identify the determinant factors of time to recovery.ResultsOf 612 fistula patients, 539(88.07%) were recovered. The Average (median) recovery time was 5.14 (IQR = 3.14, 9.14) weeks. Using Antibiotic (AHR = 1.49, 95% CI = 1.11–2.01), having history of antenatal care (ANC) (AHR = 1.95, 95% CI = 1.39–2.73), being literate (AHR = 2.23, 95% CI = 1.62–3.06), duration of bladder catheterization (AHR = 0.93, CI = 0.90–0.95) and being multiparous (AHR = 1.51, 95% CI = 1.17–1.96) were a significant predictors of the rate of recovery. Also, underweight (AHR = 0.45, 95% CI = 0.30–0.68), overweight (AHR = 0.56, 95% CI = 0.41–0.76), being obese (AHR = 0.41, 95% CI = 0.21–0.80), having extensive fistula (AHR = 0.82, 95% CI = 0.73–0.91), large fistula (AHR = 0.42, 95% CI = 0.23–0.78), medium width (AHR = 0.62, 95% CI = 0.43–0.91) and large width (AHR = 0.42, 95% CI = 0.23–0.78) were statistically significant predictors of the rate of recovery from fistula patients.ConclusionThe average recovery time from obstetric fistula patients was 5.14 weeks. Small Length and width of fistula, patients’ educational status (literacy), antibiotic use, history of antenatal care visits, normal BMI, short period catheterization and being multiparous were the significant determinate variables which shorten the recovery time of obstetric fistula.

Successful Repair of Iatrogenic Cyclical Menouria

Vesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only (1-4%) of all genitourinary fistulas. It is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment caesarean section. Patients usually present in the early post operative period with the problem of continuous urinary incontinence. On the rare occasion, recurrent urinary tract infection, recurrent gross painless haematuria, or secondary infertility associated with secondary amenorrhoea would be the presenting complaint. Among all vesicouterine fistula 90% are Youseef’s Syndrome the least common of the urogynaecological fistulas. Youseef’s syndrome is characterized by cyclic haematuria (menouria), absence of vaginal bleeding (amenorrhea) and urinary incontinence due to vesicouterine fistula (VUF).TAJ 2017; 30(1): 70-72

Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Objetivo: Analisar a relação entre a topografia da lesão cerebral e disfunção vesical em pacientes com acidente vascular cerebral (AVC) isquêmico e hemorrágico comparando a região cerebral afetada com os sintomas do trato urinário inferior (STUI).Materiais e Métodos: Estudo retrospectivo, desenvolvido no Hospital da Rede SARAH de Neurorreabilitação, Brasil, com 132 pacientes com AVC crônico atendidos no programa de reabilitação neurológica adulto, no período de janeiro de 2008 a dezembro de 2011.Resultados: Cento e seis pacientes (80,3%) apresentaram sequela de acidente vascular cerebral isquêmico e 26 (19,7%) acidente vascular cerebral hemorrágico. A média de idade foi de 56±13,1 anos e o tempo médio da ocorrência do AVC foi de 21,4 meses. Em relação ao comportamento miccional, 35,6% (n=47) eram continentes vesicais, 45,5% (n=60) com sintomas do trato urinário inferior, e 18,9% (n=25) com incontinência urinária contínua. Observou-se que na ocorrência de lesões extensas acometendo a área frontal parietal-temporal-occiptal (p=0,001), alterações cognitivas (p=0,001) e afasia (p=0,001) houve relação estatística significativa com a presença de incontinência urinária contínua nestes pacientes. Nos pacientes com lesão fronto-parietal houve associação com o sintoma urgência (p=0,050), urgeincontinência urinária (p=0,042), incontinência urinária de esforço (p=0,019) e polaciúria (p=0,042).Conclusão: Segundo a amostra estudada, observamos que alterações cognitivas e afasia tiveram correlação com a incontinência urinária contínua. Em relação a topografia de lesão cerebral houve associação entre lesões em região fronto-parietal com os sintomas de urgência, urgeincontinência, incontinência de esforço e polaciúria; e na ocorrência de lesão cerebral extensa houve prevalência de incontinência urinária contínua.

Ectopic ureter in an adolescent female with vaginal discharge: a case report

Background: An ectopic ureter inserts at a site other than the bladder neck, including urethra, vagina, and vestibule in women. These are typically diagnosed in childhood with the onset of continuous urinary incontinence after toilet training. However, they can be difficult to diagnose and rarely present in adults as urinary incontinence refractory to treatment. Case: A 17-year-old female presented with a five-year history of profuse, watery vaginal discharge and recurrent urinary tract infections, in the setting of normal voiding patterns. Discharge was initially categorized as physiologic. After months without improvement, CT urogram revealed a duplex left sided ureteral system that drained the upper moiety of the left kidney and inserted into the vagina. She was treated with surgical ureteral reimplantation. Conclusion: Ectopic ureters can commonly implant in the vagina and can rarely present with profuse, watery vaginal discharge in the setting of normal voiding patterns. Physicians must have a high index of suspicion for ectopic ureters in the patient with vaginal discharge refractory to treatment.

Incidence and risk factors of urinary incontinence in women visiting Family Health Centers.

BackgroundThe objective of this study is to determine the incidence and the risk factors of the urinary incontinence in women visiting the Health Family Center.Methods430 women, who visited three Family Health Centers in the city center of Erzurum for any reason between 25 November and 20 January 2016, were included in this study without any sampling. The data were collected by using the face-to-face interview method. Percentage distribution, Chi square test, and logistic regression analysis were used in order to analyze the data.ResultsIt was determined that 37.2 % of these women had urinary incontinence, but only 29.3 % of them visited a physician because of this complaint. Among a total of 160 women with urinary incontinence findings, stress type incontinence was observed at the highest rate (33.7 %), which was followed by mixed type (31.8 %), urge type (20.6 %) and other types (overflow, continuous urinary incontinence) (13.7 %). It was found that urinary incontinence had a significant correlation with the number of children, genital prolapse, duration of delivery longer than 24 h, diabetes and urogenital infection, but not with the age at the first and last childbirth, presence of the episiotomy, birth weight over 4 kg, and smoking.ConclusionsIt was determined that one-third of the women had urinary incontinence and certain medical and obstetric conditions were affecting the development of urinary incontinence. It is thought that it is important for the healthcare personnel to take the progression of the urinary incontinence under control by preventing the risk factors and to encourage the patients to seek treatment with the help of the proper information indicating that urinary incontinence is a treatable and preventable condition.

The Long-Term Outcome of the Turner-Warwick Vaginal Obturator Shelf Urethral Repositioning Colposuspension Procedure for Urodynamically Proven Stress Urinary Incontinence

Objective: To analyze long-term continence, voiding dysfunction and secondary prolapse rates following Turner-Warwick Vaginal Obturator Shelf Urethral Repositioning colposuspension (VOSURP) for urodynamically proven stress urinary incontinence (USUI). Patients and Methods: Telephone and/or outpatient review of the outcomes of 50 consecutive patients undergoing VOSURP between 1997 and 2008 was conducted. Outcomes assessed included urinary continence (pad free/leak free), need to self-catheterise (ISC), secondary posterior pelvic organ prolapse (POP) development and need for further continence and POP-related surgical interventions. All patients with continued/recurrent urinary incontinence had repeat videourodynamics. Results: At a median follow-up of 108.5 months (17-153), complete urinary continence was reported in 41 (82%) of patients, post procedure new onset ISC in 2 (4%) and new onset posterior POP in 2 (4%). The cause of continued urinary incontinence was persistent USUI in 3 (6%), new onset idiopathic detrusor overactivity (IDO) in 4 (8%) and failure of resolution of pre-existing IDO in 2 (4%). Conclusions: Long-term complete urinary continence and cure of USUI following VOSURP are excellent at 82 and 94%, respectively. Voiding dysfunction and secondary POP procedure rates are low. The VOSURP is an excellent alternative to classical Burch colposuspension for the treatment of primary and recurrent USUI.

Long-Term Outcome of the Pippi Salle Procedure for Intractable Urinary Incontinence in Patients with Severe Intrinsic Urethral Sphincter Deficiency

We evaluated the long-term outcome of the Pippi Salle procedure in patients with severe intrinsic urethral sphincter deficiency. We performed the Pippi Salle procedure in 6 males and 6 females with severe intrinsic sphincter deficiency between March 2003 and August 2013. Median patient age was 15 years (range 6 to 45). Mean followup was 75 months (range 17 to 142). Six males and 3 females had neurogenic intrinsic sphincter deficiency (spina bifida in 8 and spinal cord injury in 1). Three females had anatomical intrinsic sphincter deficiency (idiopathic bladder hypoplasia in 2 and pseudo-ureterocele in 1). Four patients had previously undergone bladder neck surgery, 3 had been treated with endoscopic injection of collagen, 2had undergone fascial sling and 1 had been treated with tension-free vaginal tape surgery. The Pippi Salle procedure was performed alone (2 patients), or in combination with bladder augmentation (4) or catheterizable abdominal stoma (1), or both (5). Complete dryness was achieved in 7 patients (58%). Of 9 patients with neurogenic intrinsic sphincter deficiency 7 (78%) achieved complete dryness. Eight patients experienced complications, including continued urinary incontinence (5), difficulty catheterizing per urethra (3) and urinary calculi (1). These 8patients were successfully treated with additional endoscopic interventions, including injection of collagen in 4, injection of dextranomer-hyaluronic acid in 1,transurethral incision of urethral kink in 3 and vesicolithotripsy in 1. After these simple interventions complete dryness was achieved in all 12 patients. Although we experienced some minor complications in the short term, most patients were simply and successfully treated with endoscopic surgery. The long-term results of the Pippi Salle procedure are promising.

Burden of obstetric fistula: from measurement to action.

Burden of obstetric fistula: from measurement to action.