학술논문
Urethrocutaneous fistula following VMMC: a case series from March 2013 to October 2019 in ZAZIC's voluntary medical male circumcision program in Zimbabwe
Document Type
Academic Journal
Author
Murenje, Vernon; Omollo, Victor; Gonouya, Paidemoyo; Hove, Joseph; Munyaradzi, Tinashe; Marongwe, Phiona; Tshimanga, Mufuta; Chitimbire, Vuyelwa; Xaba, Sinokuthemba; Mandisarisa, John; Balachandra, Shirish; Makunike-Chikwinya, Batsirai; Holec, Marrianne; Mangwiro, Tonderayi; Barnhart, Scott; Feldacker, Caryl
Source
BMC Urology. February 16, 2022, Vol. 22 Issue 1
Subject
Language
English
ISSN
1471-2490
Abstract
Author(s): Vernon Murenje[sup.1], Victor Omollo[sup.2], Paidemoyo Gonouya[sup.3], Joseph Hove[sup.3], Tinashe Munyaradzi[sup.4], Phiona Marongwe[sup.1], Mufuta Tshimanga[sup.4], Vuyelwa Chitimbire[sup.3], Sinokuthemba Xaba[sup.5], John Mandisarisa[sup.6], Shirish Balachandra[sup.6], Batsirai Makunike-Chikwinya[sup.1], Marrianne Holec[sup.7], Tonderayi Mangwiro[sup.8], Scott [...]
Background 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. 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. Results Case 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. Conclusion Fistula 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.
Background 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. 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. Results Case 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. Conclusion Fistula 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.