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Objective To quantify surgical and quality of life outcomes 6 months after obstetric fistula repair.Design A prospective study. Women were examined and questioned at discharge and at follow-up appointment.Setting The Barhirdar Hamlin Fistula Centre, a dedicated unit treating women with obstetric fistula in northern Ethiopia.Population All women admitted to the Barhirdar Hamlin Fistula Centre suffering from vesicovaginal (WF) and rectovaginal fistulae (RVF).Methods All women were asked to return for a follow-up appointment 6 months after surgical treatment. A standardised questionnaire and examination were used and information entered into a database.Main outcomes measures Urinary and anal continence status; extent of return to previous family situation, employment, social activities and reproductive capabilities.Results Continence status at discharge was largely maintained at 6 months and quality of life was improved. Many of those incontinent on discharge improved; a small number apparently cured at discharge had later recurrence of incontinence.Conclusions Surgical treatment for obstetric fistula is successful in maintaining continence and improving quality of life of women at 6-months follow up.

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The aim of this study is to assess the possibility of predicting the risk of failure of closure and post-fistula urinary incontinence. Women attending the fistula clinics were assessed pre-operatively, and fistulae were staged prospectively, using a previously published classification system. Assessment for fistula closure and residual urinary incontinence was performed, prior to discharge. Of the 987 women who were assessed, 960 had successful closure of their fistulae. Of those with successful closure, 229 complained of urinary incontinence following surgery. Women with fistulae located closest to the external urinary meatus had the highest rate of urinary incontinence following fistula closure. Women with significant vaginal scarring and circumferential fistulae also had significantly higher rates of urinary incontinence and higher risk of failure of closure. The classification used is able to predict women at risk of post-fistula urinary incontinence and failure of closure.

Obstetric vesicovaginal fistula is a devastating cause of urinary incontinence worldwide. More attention is being focused on treating these patients by various philanthropic societies but very little is known about the complications of surgery. One of the most common complications is that the woman is left with residual urinary incontinence despite the defect being successfully closed. If risk factors for this could be identified, then perhaps more appropriate surgical techniques could be developed with the aim of remedying the incontinence.Keywords Obstetric fistula, surgery, urinary incontinence.Please cite this paper as: Browning A. Risk factors for developing residual urinary incontinence after obstetric fistula repair. BJOG 2006; 113:482-485.

There is little information regarding the mental health status of women with genital tract fistulae in developing countries. The aim of this prospective observational study was to screen women at Dhaka Medical College Hospital, Bangladesh (December 2003 to June 2004), and Addis Ababa Fistula Hospital, Ethiopia (June to July 2004), with genital tract fistula for mental health dysfunction. Women presenting to the above institutions were screened using the General Health Questionnaire (GHQ‐28) prior to fistula surgery. As the women were illiterate, the questionnaire was completed with the assistance of a medical officer, nurse or interpreter. The female staff members acted as controls. Sixty‐eight women with fistulae and 28 controls completed the GHQ‐28. Sixty‐six of the 68 women with fistulae screened positive to probable mental health dysfunction compared with 9 of the 28 controls. We conclude that women with genital tract fistula are at high risk of mental health dysfunction. If the high rates of positive screening are confirmed on psychiatric evaluation, then the management of women with genital tract fistulas must include routine psychological/psychiatric assessment and treatment.

Obstetric fistula is estimated to affect 2 million women worldwide and has considerable social and psychological effects on affected individuals. In this prospective study, 51 consecutive women with obstetric fistula admitted to the Barhirdar Hamlin Fistula Centre in the north of Ethiopia were screened using the General Health Questionnaire (GHQ‐28) for potential mental health disorder before and 2 weeks after fistula surgery. Prior to surgery, all women screened positive. By 2 weeks after, this had dropped to 36% (P = 0.005). 27% of the 45 women who were cured of their incontinence screened positive, while all 6 of those with severe residual incontinence continued to screen positive. We conclude that surgical treatment of obstetric fistula results in marked improvements in mental heath.

Obstetric vesico-vaginal fistula remains a significant cause of female urinary incontinence worldwide. Approximately 2 million women suffer from this condition, perhaps many more, most of whom are in Africa. Very few centres are treating these patients, and although success rate in the closure of the fistula is high, up to 92%, this does not necessarily equate to a cure. A significant proportion of women remains with urinary incontinence. Little is known about the nature of this incontinence, and even less is known about how to manage it. This article describes a new and simple surgical procedure, which, when employed at the time of fistula closure, seems to reduce the incidence of residual incontinence in those women at a higher risk of developing it.