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Baseline renal function and renal ultrasound findings in patients with obstetric fistulas (RENFRU): a prospective cohort study.
- Source :
-
BJOG : an international journal of obstetrics and gynaecology [BJOG] 2020 Jun; Vol. 127 (7), pp. 897-904. Date of Electronic Publication: 2020 Feb 19. - Publication Year :
- 2020
-
Abstract
- Objective: To describe and compare baseline renal anatomy and renal function in patients with obstetric fistulas, and to evaluate whether preoperative renal testing and imaging may aid with operative decision making.<br />Design: A prospective cohort study.<br />Setting: Fistula Care Centre in Malawi.<br />Population: Women with an obstetric fistula.<br />Methods: Baseline creatinine testing and renal ultrasounds were performed. Surgeons completed a short questionnaire on the usefulness of creatinine and renal ultrasound on operative decision making.<br />Main Outcome Measures: Baseline creatinine and renal ultrasound findings.<br />Results: Four surgeons performed operations on 85 patients. The mean creatinine in patients with vesicovaginal fistulas (VVF) was 0.60 ng/ml versus patients with uretero-vaginal fistulas (UVF) (0.79 ng/ml, P = 0.012). When a grade 3 or more hydronephrosis is absent on renal ultrasound, the negative predictive value of the presence of UVF is 93.3% (95% confidence interval [CI] 88.6-96.2) with a specificity of 97.2% (95% CI 90.3-99.6). In cases of UVF, surgeons found the renal ultrasound results useful or very useful 87.5% of the time, and the creatinine useful or very useful 75% of the time.<br />Conclusion: In this pilot study, most patients with obstetric fistulas presented with a normal creatinine. In the absence of a grade 3 hydronephrosis or above on renal ultrasound, the probability of not having a UVF is 93.3%. Surgeons should consider performing preoperative renal ultrasound testing in all patients with an obstetric fistula, particularly in women with a prior laparotomy, as this population has risk factors for ureterovaginal fistula.<br />Tweetable Abstract: Most patients with obstetric fistulas have normal renal function. Preoperative renal ultrasounds should be performed.<br /> (© 2020 Royal College of Obstetricians and Gynaecologists.)
- Subjects :
- Adult
Female
Humans
Kidney Function Tests methods
Malawi epidemiology
Outcome and Process Assessment, Health Care
Pregnancy
Preoperative Care methods
Preoperative Care standards
Prospective Studies
Quality Improvement
Surgical Procedures, Operative adverse effects
Surgical Procedures, Operative methods
Ultrasonography methods
Kidney diagnostic imaging
Obstetric Labor Complications diagnosis
Obstetric Labor Complications epidemiology
Obstetric Labor Complications surgery
Urinary Fistula diagnosis
Urinary Fistula epidemiology
Urinary Fistula etiology
Urinary Fistula surgery
Vesicovaginal Fistula epidemiology
Vesicovaginal Fistula etiology
Vesicovaginal Fistula surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1471-0528
- Volume :
- 127
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- BJOG : an international journal of obstetrics and gynaecology
- Publication Type :
- Academic Journal
- Accession number :
- 31961472
- Full Text :
- https://doi.org/10.1111/1471-0528.16106