Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study

Abstract

Objective We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously. Design Prospective cohort study. Setting Fistula Care Centre in Lilongwe, Malawi. Population Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment. Methods Self‐report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire‐9; quality of life was evaluated with the King's Health Questionnaire. Main outcome measures Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation. Results Fifty‐six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre‐operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61–5.27) or Goh type 4 1.08–2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24–4.71) and the positive 1‐hour postoperative pad test (aRR = 2.20; 95% CI 1.08–4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence. Conclusions While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at‐risk group. Tweetable abstract Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.

Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019

“…In such a context, residual incontinence, which may be perceived as fistula repair failure, represents a heavy burden for the woman and her family, given its social, economic and therapeutic implications (12)(13)(14)(15). Several authors report that post-repair residual incontinence results in continued stigmatization and social withdrawal, contributing to ongoing mental distress among women affected by fistula (12,(16)(17)(18)(19)(20). The persistent physical disability of incontinence may limit a woman's productivity and, in turn, her quality of life (6,21).…”

Assessment of health-related quality of life of vesicovaginal fistula patients attending a repair center in Northwest Nigeria

“…Successful repair of VVF may have led to relief from persistent urinary leakage and perineal wetness giving rise to improved hygiene, sleep pattern and work capacity. [ 4 9 14 15 ] However, this score was still lower than scores reported from other studies in India[ 9 ] and southern Nigeria. [ 4 ] Psychological domain (which reflects positive feelings, bodily image and appearance, self-esteem, personal beliefs) was also lower than that observed in a previous study conducted in India,[ 9 ] and southern Nigeria.…”

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

“…While other analyses attempted to estimated costs associated with delayed diagnosis in LUTI, they did not quantify disutility (aka harm) that the patient experiences when they are subject to injury; as such, the prior analyses are more accurately described as cost-benefit analyses (26). Meanwhile, our analysis used QALYs to account for decreased quality of life experienced by the patient as a result of their compilations of surgery (27,28). These effects are not reflected in direct healthcare utilization and inclusion of QALYs allows us to incorporate these considerations into our economic analysis generating a full cost-effectiveness analysis.…”