{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:25:09Z","timestamp":1786119909852,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To present a 16\u2010year multinational experience of 1185 female genital fistula (FGF) repairs performed by a single surgical team, emphasizing the integration of classical techniques with adjunctive innovations across diverse clinical settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This structured observational study included 1185 FGF repairs conducted from 2009 to 2025 across 12 countries. Data collected included patient demographics, fistula etiology and type, prior repairs, surgical approach, use of adjuncts, and postoperative outcomes. Primary outcomes were anatomical closure and functional recovery. Secondary outcomes included postoperative complications and psychosocial reintegration of the patients into their families and societies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results and Limitations<\/jats:title>\n                    <jats:p>Vesicovaginal fistulas accounted for 64% of cases, followed by urethrovaginal (12%) and rectovaginal (11%). Obstetric trauma and iatrogenic injury were the leading causes (59% and 34%, respectively). Fistulas were classified as simple (36%), recurrent (56%), or complex (8%). Overall closure rate was 82%, highest among simple (91%) and primary (85%) cases. Adjuncts such as platelet\u2010rich plasma (PRP), small intestinal submucosa (SIS), fibrin glue, and buccal grafts were used in 71% of complex\/recurrent repairs, with a 72% closure rate in this subgroup. Residual incontinence after successful closure of fistula affected 12% of patients, most of whom improved with bulking agents (72%) or pubovaginal slings (91%). Complication rates included urinary tract and wound infections (5%) and recurrence of fistula (18%). Limitations include retrospective design and heterogeneity in adjunct usage. Another main limitation is our follow\u2010up regimen, which was not done by our surgical team in all countries included. Nevertheless, treatment of residual incontinence was not performed solely by our team, and thus this affected success rate of residual incontinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combining traditional surgical methods with adjunctive techniques enables high closure and functional recovery rates in FGF repair, even in low\u2010resource settings. Selective use of adjuncts supports tissue healing in complex cases and may enhance long\u2010term success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Summary<\/jats:title>\n                    <jats:p>In this multinational study of 1185 FGF surgeries, integrating traditional and innovative techniques led to high closure rates and improved continence and quality of life even in resource\u2010constrained countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Registration<\/jats:title>\n                    <jats:p>This study does not require clinical trial registration as it is an observational, retrospective analysis of anonymized surgical cases (2009\u20132025).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70226","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T06:02:37Z","timestamp":1770098557000},"page":"583-590","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sixteen Years of Multinational Experience in Female Genital Fistula Repair: Integrating Traditional and Innovative Surgical Approaches Across 12 Countries"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6399-2279","authenticated-orcid":false,"given":"M. Sherif","family":"Mourad","sequence":"first","affiliation":[{"name":"Department of Urology Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Malallah","sequence":"additional","affiliation":[{"name":"Kuwait Institute of Medical Specialization (KIMS) Andalous Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wally","family":"Mahfouz","sequence":"additional","affiliation":[{"name":"Department of Urology Alexandria University Alexandria Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Saafan","sequence":"additional","affiliation":[{"name":"Department of Urology Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Farouk","sequence":"additional","affiliation":[{"name":"Department of Urology Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Yassin","sequence":"additional","affiliation":[{"name":"Department of Urology Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Metwaly","sequence":"additional","affiliation":[{"name":"Department of Urology Suez University Suez Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Shaker","sequence":"additional","affiliation":[{"name":"Department of Urology Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Urinary Fistula","author":"Sotelo R.","year":"2023"},{"key":"e_1_2_11_3_1","unstructured":"WHO. Obstetric Fistula: WHO Regional Office for the Eastern Mediterranean 2024 https:\/\/www.emro.who.int\/media\/news\/international-day-to-end-obstetric-fistula-call-for-quality-maternal-health-care-for-all.html."},{"key":"e_1_2_11_4_1","unstructured":"WHO African Region Obstetric Fistula Strategic Plan 2022\u20132026: Ending Obstetric Fistula in the WHO African Region (WHO African Region 2022)."},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.02.015"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2023.1188809"},{"issue":"1","key":"e_1_2_11_7_1","first-page":"S47","article-title":"Simple Fistulas: Diagnosis and Management in Low\u2010Resource Settings\u2014A Descriptive Report","volume":"99","author":"Lassey A. 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