Commentary of the Best abstract: “Reducing Iatrogenic Genitourinary Fistula in Uganda: The Impact of a short-Term Essential Training in Operative Obstetrics: ETOO”

The abstract entitled “Reducing Iatrogenic Genituorinary Fistual in Uganda: The Impact of a Short-term Essential Training in Operative Obstetrics: ETOO” by Byamukama et al was awarded Best Abstract this year at the 2025 IUGA/EUGA conference in Barcelona, Spain. Dr. Byamukama and his team at the Mbarara University of Science and Technology in Uganda developed an in-service training program for junior doctors to address gaps in knowledge and technique to prevent iatrogenic fistulae. The program was launched in 2022 at 5 public health facilities in Western Uganda and involves 5 days of theoretical and simulation-based training as well as at least 2 weeks of hands-on experience with at least 6 supervised cesarean deliveries under trained obstetrician and gynecologic specialists.

To evaluate the impact of this Essential Training in Operative Obstetrics ETOO), the investigators conducted a retrospective review comparing incidence of fistula from 2020-2021 (pre-implementation of ETOO) and from 2022-2024 (post-implementation of ETOO). The findings of the study are compelling: the incidence of fistula repair dropped from 39 cases in 2020 to 19 in 2024. Based on their findings, they estimated a reduction of over 5 fistula cases every year after the implementation of ETOO.

This abstract is particularly noteworthy for its combination of practical intervention and real-world applicability to combat a devastating and preventable obstetrical complication. The training model is not only context-appropriate for resource-limited settings, but its short duration and targeted focus make it ideal for rapid implementation. In the 2 years after the launch of ETOO, 123 physicians were trained which has rippling downstream effects to the trainees they can go on to mentor.

The study’s strength lies in its use of clinical data from multiple referral centers and its clearly defined objective outcome of surgical repair of genitourinary fistual. The decline in cases following ETOO implementation provides early, yet persuasive, evidence that structured operative training can meaningfully improve maternal surgical outcomes.

Another key strength of this abstract is its attention to equity and systems-level improvement. The majority of affected patients were rural women, highlighting the disproportionate impact of surgical complications in underserved communities. Furthermore, the data point to persistent challenges in private facilities—an important insight that reinforces the need for nationwide training expansion and broader health systems engagement.

By identifying a scalable strategy to reduce harm during one of the most common surgical procedures worldwide, this work represents a powerful model for addressing surgical safety that demands standardized training and best-practice to care for the women of Uganda. It exemplifies the type of research that is grounded in local context, guided by global priorities, and capable of informing meaningful policy change.

Congratulations to the authors for this outstanding and impactful contribution to the field of urogynecology and maternal health.

Sarah Rozycki, MD

Houston Methodist Hospital

Division of Urogynecology

Houston, TX