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

Abstract

BackgroundDespite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC).Material and MethodsThis was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence.ResultsOverall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21).ConclusionPrior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.

Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia

“…However, this percentage was greater than that reported in previous studies conducted in India (18.5%) [ 21 ], the DRC (4.3%) [ 13 ], Guinea (13.36%) [ 11 ], Burkina Faso (11.7%) [ 25 ], and Ethiopia (Jimma Specialized Hospital) (8.9%) [ 8 ]. This difference might be due to the causes of VVF, the setting difference for instance, in DRC, where data were collected from 3 fistula centers, unlike this study [ 13 ], and a longer duration of the period (10 years) used to collect data in Guinea [ 11 ], and the difference in patient individual characteristics.…”

“…Despite the highest successful closure of VVF repair, UI is a common and challenging public health problem among patients who underwent VVF repair [ 11 , 13 , 14 ]. Patients with UI experience wetness, odor, and discomfort [ 15 ], which have significant consequences for social and emotional problems such as relationship problems, depression, and suicidal ideation [ 16 ] and can affect women’s quality of life [ 17 – 19 ].…”

“…In SSA, retrospective cohort studies demonstrated that in the Democratic Republic of Congo (DRC), between 2017 and 2019 (4.3%) [ 13 ], in Guinea (13.36%) [ 11 ], in Malawi between September 2011 and December 2014 (24%) [ 24 ]. A retrospective cross-sectional review conducted in Burkina Faso between 2010 and 2016 revealed 11.7% of patients with UI [ 25 ] and in Niger between 2011, 2013 and 2014 (63.9%) [ 26 ].…”

“…Another study conducted in Guinea also found that partially or totally damaged urethra status was a contributing factor for post-fistula repair UI [ 29 ]. A study performed in the DRC showed that previous history of surgery and vaginal route repair were risk factors [ 13 ]. Moreover, a study performed in India revealed that the size and site of the fistula were risk factors [ 21 ].…”