Worldwide, an estimated 2-3.5 million women are affected by severe physical, mental, social and economic impairment due to vesicovaginal fistula. A vesicovaginal fistula is an abnormal opening between the bladder and vagina that is formed due to extensive tissue damage in the female pelvis. The abnormal opening allows continuous, uncontrollable leakage of urine that has a severe impact on the quality of life of affected women. In the developing world, it is mostly the result of prolonged obstructed labor when there is no timely obstetric intervention (e.g., caesarian section or assisted delivery). Less common causes that are mostly seen in the developed world are complications of surgery, radiation and/or malignancies in the female pelvis. For almost all cases, surgical repair is the only solution. However, repairing the damaged tissue is a major surgical challenge due to poor quality of tissue, excessive scarring and poor blood circulation in the surrounding tissue; creating a hostile and unforgiving environment for repair. Closing the opening between the bladder and vagina and subsequent regaining of urinary, sexual and reproductive function are endangered by lack of healthy tissue to achieve satisfactory closure, often compromising these different important bodily functions.
Between 30,000 and 130,000 new fistulas develop annually in Sub-Saharan Africa alone. Poor socioeconomic status, early marriage, malnourishment, low literacy rate, barriers to sexual and reproductive health services and poor healthcare systems in general, contribute to the high prevalence of obstetric fistula in these countries. Fistulas creates a social stigma for the affected women and retards their overall development. Women often get divorced an excommunicated by society due to their inability to fulfil their societal roles as mother and wife. Affected women, in their prime productive period of life, lose the potential for growth and excellence in society. This severely affects mental health and results in depression, anxiety and suicide.
We aim to simultaneous achieve four objectives in a sustainable way.
1. Improving fistula care by delivering surgical innovations in the field of obstetric fistula repair to significantly improve the lives of millions of women worldwide by developing a tissue engineered solution to successfully treat obstetric fistulas taking into account societal, political and health care
circumstances.
2. Relieving suffering of women with obstetric fistula by providing surgical care.
3. Educating and training of local doctors and nurses to build capacity and provide long-term care.
4. Creating awareness in local communities to reduce stigmatisation and educate on prevention and cure.
POWER foundation will use its strong network of academic institutions, industry contacts and product innovators to translate new innovations to the surgical repair of obstetric fistulas including developing the regenerative tissue patch, engaging with the surgeon community as well as improving patient and nurse education. New breakthroughs will be implemented in the education and training of surgeons to equip them with the most cutting-edge techniques and latest insights. Innovation will strengthen the capacity building by simplifying and improving the surgical solutions we can offer patients. Within the network of the POWER foundation, multiple studies have been conducted on optimising the healing condition of the vagina and improving surgical closure techniques (e.g., transplanting healthy tissue, introducing biomaterials for the repair). The teams will use the initiative to translate these (pre-)clinical findings to healthcare providers and patients.
Professor Jan-Paul Roovers completed his training as a Gynaecologist at the University Medical Centre Utrecht and his fellowship in Urogynaecology at UZ Gasthuisberg, Leuven. He has worked as an Urogynaecologist at the Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, since 2006, was head of the gynaecology department from 2012 - 2018 and became professor in gynaecology in 2014.Since 2016 he is an honorary professor at the University of Cape Town. Prof Roovers founded the pelvic floor centre of Amsterdam in 2008, which is now the largest pelvic floor centre in his country and part of a chain of private hospitals called Bergman Clinics. In this chain of 60 hospitals with a focus on orthopaedic and aesthetic surgery, Roovers is the medical director of research and innovation. Roovers leads a research group with 20 researchers, has authored over 200 peer-reviewed articles, chaired the EUGA meeting in 2016 and IUGA meeting in 2020 and is an associate editor of Neuro-urology and Urodynamics.
Professor Stephen Jeffery is a Royal College (London) accredited subspecialist Urogynecologist. A large portion of his time is spent doing clinical work which includes heading the Department of Urogynaecology and Pelvic Floor Reconstruction at the University of Cape Town. He is one of the only accredited Urogynaecologist in South Africa.As president of the South African Urogynaecology Association, Dr Jeffery was instrumental in the formalising the accreditation of the Urogynaecology as a subspeciality in South Africa. Prof. Jeffery specialises in surgery for pelvic organ prolapse and urinary incontinence. He has a broad research interests in the field of Urogynaecology including novel techniques in prolapse surgery, fistula and minimally invasive techniques of incontinence
After completing his Masters, Lennart began his professional career at the Department of Obstetrics and Gynaecology at the St. Antonius Hospital in Utrecht. Simultaneously, he embarked on his Ph.D. journey at Amsterdam UMC, focusing on obstetric fistula under the guidance of Prof. Dr. J.P.W.R. Roovers. This research seamlessly merged his interests in Obstetrics and Gynaecology, sexual and reproductive health, and global health. In 2021, Lennart relocated to Cape Town with his wife, Irene, to work remotely as an International research affiliate at the University of Cape Town. He was integrated in the Biomaterials research group of Prof. Dr. D. Bezuidenhout. Working from South Africa gave the opportunity to study obstetric fistula up close in its context, work together with material scientists and conduct the first animal experiments. The innovative and experimental surgical work in Cape Town won the Dr. Klopperprijs, an acknowledgement by SEOHS for the efforts to bring surgical innovation to the field of obstetric fistula.
2024 Thesis by Maljaars, L.P - "Surgical care and innovation for vesicovaginal Fistula"
Publication date: 2024
Document Version: Final published version
Surgical care and innovation for vesicovaginal fistula
Maljaars, L.P.
Publication date: 2024
Document Version: Final published version
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