Healthcare Trends 2019



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WHO recommends shorter catheterisation after urinary fistula repair

The World Health Organisation (WHO) has recommended a seven- to 10-day bladder catheterisation following surgical repair of a simple obstetric urinary fistula to allow complete healing.
Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Photo: Kate Holt / AusAID
Currently, the length of catheterisation is not standard and ranges from five to 42 days. Longer periods of catheterisation can be inconvenient for the woman, her family and care providers as it is associated with more discomfort. It also increases the risk of infection and erosion and requires more intensive nursing care and costs more per patient.

New WHO recommendation

The intervention can be implemented by any appropriately trained surgeon, including one with less experience, and it has direct health and cost implications in low- and middle-income countries.

Shorter periods of post-operative bladder catheterisation have been tested in simple cases of obstetric fistula and shown to be effective in allowing complete healing with improved patient comfort and potentially lower risks of catheter-related urinary tract infections.

This in turn means less intensive nursing care is required, shorter hospital stays and thus reduced costs for the health system. With shorter stays in hospital it should be possible to increase the number of fistula patients who could receive treatment using the existing facilities.

The primary target audience for this guideline is healthcare professionals, particularly fistula surgeons and nurses providing post-operative care to women after surgery for obstetric urinary fistula. The guideline will also be useful to national and local policy-makers, and staff of nongovernmental and other organisations involved in fistula care services.
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