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Innovative Education
Researchers Design Novel Vesicovaginal Fistula Repair Model
Researchers Design Novel Vesicovaginal Fistula Repair Model
In the absence of modern obstetric care, obstructed labor can cause up to 4.7 percent of women in low-resource settings to develop vesicovaginal fistulas (VVF).
VVF is a condition in which there is an abnormal connection between the bladder and vagina. Left untreated, VVFs result in constant urine leakage that increases the risk of urinary tract infections and moisture-associated skin damage.
Rachel A. High, DO
“Social stigmas are also associated with this condition,” explained Rachel A. High, DO, Assistant Professor of Obstetrics and Gynecology. “Constant urine leakage can impact mental and emotional well-being and daily life—it can even be difficult to leave the house. Unfortunately, women with this condition may be shunned by partners and family.”
Surgeons skilled in VVF repair in low-resource settings are scarce. Even in high-resource settings, such as the U.S., success rates of VVF repair vary due to a lack of training opportunities. As a result, urogynecologists may lack readiness in performing this surgery.
The lack of training opportunities and the global need for skilled surgeons in VVF repair led High to design the first low-fidelity transvaginal VVF repair simulation model. Priced under $70, the low-fidelity design increases accessibility in low-resource settings since the model is made of common, low-cost materials that can be used repeatedly. A demonstration video also shows how to put the model together.
The methodology behind the model’s development and effectiveness is outlined in High’s recent study published in Urogynecology. To develop the model, the research team worked with a group of experts in VVF repair to create a list of steps for the procedure. A separate group of experts tested the model and provided feedback on how well the model performed for each step.
The model consists of all anatomic structures important in vesicovaginal fistula repair, including a bony pelvic base and pelvic viscera, a vaginal epithelium and fibromuscular layer, bladder muscularis and mucosa, ureters and anus.
It's nice to help people in other countries, but it's even better if we can transfer skills so they can continue helping patients and treating new cases.
Rachel A. High, DO
Assistant Professor, Obstetrics and Gynecology
Based on this feedback, the model performed well at simulating its primary objective, which was closure of the fistula, but it did not perform well when simulating cystoscopy, which involves filling the bladder with fluid and placing a camera inside the bladder. However, this shortcoming does not limit the value of the model.
“There are many existing models for cystoscopy or looking inside the bladder,” High said. “Many training models exist to learn cystoscopy skills, and cystoscopy is also a procedure that trainees perform frequently in numerous of other surgeries. Our model is still significant as it helps hone vital VVF repair skills that trainees might not have an opportunity to fully develop.”
The low-fidelity design increases accessibility in low-resource settings since the model is made of common, low-cost materials that can be used repeatedly.
High is looking forward to the model being used to address surgical training gaps close to home and abroad.
“We developed this model with a global health perspective,” High emphasized. “It's great to help people in other countries, but it's even better if we can transfer skills so they can continue helping patients and treating new cases.”
Laura M. Kent, MD, Emily K. Vinas, EdD, Mary M. Rieger, MD, MAS, Lauren Caldwell, MD, Amanda B. White, MD, and Rachel A. High, DO
Callie Rainosek Wren, MS
July 2025
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