New hope for women with fistula injuries

The health care systems in the United States and other industrialized countries have outgrown many of the childbirth-related injuries that are still very problematic in poor countries.

One of those is fistula, defined as a hole between the vagina and bladder that causes constant urine leakage through the vagina. In the Democratic Republic of Congo, where treatment for fistula isn't advanced and health care resources are scarce, a fistula injury is potentially catastrophic.

Part of the problem is that doctors don't have a good way to gauge the degree of the fistula injury in order to develop the appropriate treatment plan, said Janis Miller, a professor at the University of Michigan Nursing School and one of the authors of a new study on assessing and treating this injury.

To that end, Miller and her partners in the Congo have developed a method of scoring fistula injuries that will guide clinicians in determining treatment. They can either fix the fistula themselves or refer the woman to a specialist.

The tool, called the Panzi Score, will help physicians predict the success of surgery and make a path for treatment, said study co-author Alain Mukwege, a research associate at the U-M School of Nursing.

"If a fistula happens again, there is a greater risk of failure," Mukwege said.

Often, women having difficult labors in developing countries must wait for days for medical treatment, and in the meantime, tissue begins to die. The more tissue death there is, the tougher a fistula is to repair.

The condition can be socially and physically catastrophic for women, Miller said. The women are usually socially isolated and the leakage is acidic and constant, causing horrible sores.

The study included 837 women with fistula injuries who were treated at the Panzi Hospital DRC and its outreach clinics. Fistula severity was assessed and surgical success was ascertained, and researchers analyzed the data to select fistula characteristics predictive of surgical failure.

Miller said the Panzi Score was surprisingly accurate, and she hopes it will be widely adopted.

The study, "Panzi score as a parsimonious indicator of urogenital fistula severity derived from Goh and Waaldijk classifications," appears in the International Journal of Gynecology and Obstetrics.