What About Her Kidneys? Fistula Repair In Low-Resource Settings

Worrying about renal status of patients undergoing operations for urogenital fistula has long been on the mind of surgeons in low-resource settings. In developed locations, few would dispute that baseline serum renal function and urinary tract imaging would be considered standard of care. But transition to locations of the vast majority of urogenital fistulas worldwide, and one must negotiate the chasm between ideal or proper and that which is realistic and cost-effective. The truth is, hospitals managing large numbers of fistulas are often markedly limited in what is available and therefore must weigh if potential benefits of testing justify the costs.