Cairo 2010

FIRST ICS FISTULA WORKSHOP - A REVIEW BY TWO PARTICIPANTS Held at Ain Shams University Hospital in Cairo, 16-17 January 2010  Susan Hobson (USA), Medina Ndoye (Senegal)

The ICS recently formed a new committee on obstetric fistula in developing countries with several aims, one of which is to provide education and training in surgical techniques for vaginal fistula to physicians in countries where the problem is endemic but who may not yet have access to training. 

The first ICS Fistula Workshop was held at Ain Shams University Hospital in Cairo, 16-17 January 2010, in collaboration with the Pan Arab Continence Society (PACS). The workshop was led by Professor Sherif Mourad together with his associates Drs. Farahat, Farouk, Omar, Osman, Saafan, Shaker and Yassin. The participants were urologists, gynaecologists, and urogynaecologists from Senegal, Benin, El Salvatore, Honduras, USA, United Kingdom, Indochina, Saudi Arabia and South Korea. Some came from countries where obstetric fistula is endemic, or endemic in neighbouring countries, while others had a special interest in going to areas where this physically and socially debilitating medical tragedy occurs in order to help as a surgeon. Some participants in poorly funded countries were supported by the ICS for the cost of travel and the workshop.

The first part of the workshop was devoted to presentation of the multiple and complex aspects of fistula epidemiology and some of the common religious, social and political characteristics of the populations most affected. In developed countries, vesicovaginal and rectovaginal fistulae are a complication of surgery, radiation, malignancy or trauma. In poor, underdeveloped countries, obstetric fistulae are a widespread consequence of a public health problem and are caused by prolonged, obstructed labour. Each year, 50 to 100 thousand new cases are added to the estimated 2 million already affected and awaiting care. The problem is daunting and afflicts countries in both hemispheres and is exacerbated by the low socio-economic level of many countries in Africa and Asia, by early marriage, lack of education and malnutrition, added to the inadequacies of sanitary systems and harmful practices such as excision. The result is social isolation, stigmatization and often desertion by the husband.

The issue of training and retaining local surgeons in repair of fistula was also touched on, as was the overwhelmingly vast number of women affected versus the number of available trained surgeons and the problem of social and psychological rehabilitation after surgery.

The pathophysiology of fistula formation, current classification and initial management and repair of obstetric fistulae were then presented by Prof. Mourad and his associates, who have considerable experience in fistula repair through medical missions in nearby affected countries. Egypt itself now has a low incidence of obstetric fistula due to modern obstetric practice. 

We were then involved intraoperatively with the repair of 6 fistula cases with variable causes. Due to the small group size, we were each able to participate in a hands-on experience in the OR on at least 2 cases. Thanks to state-of-the-art audio-visual equipment and a highly talented cameraman, we were able to visualize the surgery and interact with each other and the operating surgeons so as to fully experience each of the 6 surgeries. 

It was an amazing experience for us all. For some participants, it was the first experience with fistula. One participant who had some experience in his practice said that he now felt much more confident to use the techniques he had just learnt, while another was really excited to be equipped with the requisite experience and know-how to be able to operate on cases waiting for him at his hospital. 

It should not be left unsaid that the collegiality and hospitality of our hosts and the ICS was unsurpassed, and that our experience of authentic Cairo cuisine and nightlife was superb. 

To conclude, obstetric fistula is a complex problem surrounded by taboos and socio-cultural issues. We have to give these women a chance to be cured and the ICS can help by giving us the opportunity to learn how to treat this devastating but non-fatal disease.

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