title: Urinary diversion for patients with inoperable obstetric vesicovaginal fistula: the Jos, Nigeria experience.
abstract: BACKGROUND
  Repair of obstetric urinary fistula may result in successful fistula closure, but often incontinence persists. Our goal was to review our experience with continent urinary diversion in our patients with inoperable vesicovaginal fistula (VVF).
  
  
  METHODS
  The database of patients who underwent urinary diversion at ECWA Evangel VVF Centre in Jos, Nigeria, between 1996 and 2012, was reviewed. Complications and surgical outcomes were noted. The earlier patients (1996-2002) and the later patients (2003-2012) were compared.
  
  
  RESULTS
  Urinary diversions were performed on 118 patients. Compared with the earlier patients, the later patients more often underwent modified Mainz II diversions, had similar complication rates, but had better outcomes. The use of ureteric catheters intraoperatively and the performance of modified Mainz II pouch were associated with a better outcome. Overall perioperative mortality was 2.5 %.
  
  
  CONCLUSIONS
  Urinary diversion is feasible in a low-resource setting. Use of modified Mainz II pouch diversion and intraoperative ureteric catheters were associated with a better outcome. Urinary diversion should be undertaken only after the careful counseling of each patient, and by an experienced surgeon.
authors.affiliation: ECWA Evangel VVF Centre (now Bingham University Teaching Hospital), Jos, Nigeria. ckirschner@northshore.org.|North Shore University Health System, 2650 Ridge Avenue, Walgreen Building Suite 1507, Evanston, IL, 60201, USA. ckirschner@northshore.org.
authors.forename: Carolyn V
authors.initials: CV
authors.lastname: Kirschner
authors.affiliation: ECWA Evangel VVF Centre (now Bingham University Teaching Hospital), Jos, Nigeria.|Fistula Foundation, San Jose, CA, USA.
authors.forename: Sunday J
authors.initials: SJ
authors.lastname: Lengmang
authors.affiliation: North Shore University Health System, 2650 Ridge Avenue, Walgreen Building Suite 1507, Evanston, IL, 60201, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: ECWA Evangel VVF Centre (now Bingham University Teaching Hospital), Jos, Nigeria.
authors.forename: George A A
authors.initials: GA
authors.lastname: Chima
authors.affiliation: ECWA Evangel VVF Centre (now Bingham University Teaching Hospital), Jos, Nigeria.|Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Karshima
authors.affiliation: ECWA Evangel VVF Centre (now Bingham University Teaching Hospital), Jos, Nigeria.|Fistula Foundation, San Jose, CA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Arrowsmith
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D009549:Nigeria; D012189:Retrospective Studies; D014547:Urinary Diversion / Q000379:methods / Q000706:statistics & numerical data*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000150:complications / Q000601:surgery*; D055815:Young Adult
keywords: Diversion; Fistula; Inoperable; Mainz; Urinary