Validation of a culturally compliant voiding platform for urodynamics in African vesicovaginal fistula patients

Introduction and hypothesis Most patients in regions where obstetric vesicovaginal fistulas (VVF) are endemic void using a squatting posture. Additionally, many patients continue to have lower urinary tract symptoms (LUTS) following fistula closure. We designed and validated a prototype platform tha...

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Bibliographic Details
Published in:International Urogynecology Journal 2015-05, Vol.26 (5), p.749-755
Main Authors: Borazjani, Ali, Tadesse, Helina, Ayenachew, Fekade, Goldman, Howard B., Damaser, Margot S., Wall, L. Lewis
Format: Article
Language:English
Subjects:
Adult
Africa
Culturally Competent Care
Diagnostic Techniques, Urological - instrumentation
Female
Gynecology
Humans
Lower Urinary Tract Symptoms - etiology
Lower Urinary Tract Symptoms - physiopathology
Medicine
Medicine & Public Health
Middle Aged
Original Article
Pilot Projects
Posture
Urination
Urodynamics
Urology
Vesicovaginal Fistula - complications
Vesicovaginal Fistula - surgery
Young Adult
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Summary:Introduction and hypothesis Most patients in regions where obstetric vesicovaginal fistulas (VVF) are endemic void using a squatting posture. Additionally, many patients continue to have lower urinary tract symptoms (LUTS) following fistula closure. We designed and validated a prototype platform that allows urodynamic studies to be performed in a squatting position and conducted a pilot study to assess uroflowmetry in this patient population. Methods Sixteen patients with persistent LUTS following fistula surgery were recruited. Posture measurements were taken in each patient’s natural voiding posture on the ground and were then repeated using the platform. Nine patients with persistent urinary incontinence also underwent uroflowmetry. The data were compared with normal values in different nomograms. Paired t tests were used to determine significant differences in posture. One-way ANOVA was used to determine statistical significance between flow rate values. Results Only the heel-to-heel distance (H-H) measure of posture was significantly increased on the platform compared with on the ground. The mean corrected Qmax was 0.89 ± 0.46. Flow rate values were significantly lower than mean normal flow rates obtained from the nomograms. In general, the patients’ uroflowmetry patterns were similar to those indicative of impaired detrusor function. Conclusion A platform for conducting urodynamic studies in a squatting posture was successfully validated in the VVF patient population. The finding of increased H-H on the platform is expected, since the patient must accommodate a large funnel for urine collection. The pilot data suggest that patients with persistent urinary incontinence following VVF closure may also have significant voiding dysfunction.
ISSN:0937-3462
1433-3023
DOI:10.1007/s00192-014-2575-7