title: Validation of a culturally compliant voiding platform for urodynamics in African vesicovaginal fistula patients.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Global Innovations for Reproductive Health & Life, Cleveland, OH, USA, borazjani@girhl.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Borazjani
authors.forename: Helina
authors.initials: H
authors.lastname: Tadesse
authors.forename: Fekade
authors.initials: F
authors.lastname: Ayenachew
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
authors.forename: Margot S
authors.initials: MS
authors.lastname: Damaser
authors.forename: L Lewis
authors.initials: LL
authors.lastname: Wall
mesh_terms: D000328:Adult; D000349:Africa; D065246:Culturally Competent Care; D003950:Diagnostic Techniques, Urological / Q000295:instrumentation*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D010865:Pilot Projects; D011187:Posture; D014554:Urination; D014563:Urodynamics; D014719:Vesicovaginal Fistula / Q000150:complications* / Q000601:surgery; D055815:Young Adult