The ethical and technical aspects of urinary diversions in low‐resource settings: a commentary

Obstetric fistula as a result of obstructed labour is still a vexing problem in low-resource settings. Surgery is typically the only successful treatment. Up to 86% of women are successfully repaired on the first surgical attempt; however, a minimum of 10-15% will have either a residual fistula or residual pelvic floor disorders, such as stress incontinence. A woman can be deemed to be 'irreparable' as a result of the primary injury or after subsequent repairs. The only option available for cure is urinary diversion. Urinary diversions involve greater levels of intra-operative and post-operative risks when compared with standard vaginal surgery. There are numerous medical, ethical and cultural issues to consider, all of which are magnified in low-resource settings.