Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center

Abstract

Introduction and hypothesisThe impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure.MethodsThe medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as “easy,” “of intermediate complexity,” or “difficult” based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression.ResultsThe patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success (“closed and dry”) was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for “easy” cases, 68% for “intermediate” cases, and 57% success for “difficult” cases. Success decreased with increasing numbers of previous attempts at surgical repair.ConclusionsThese data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.

A retrospective review to identify criteria for incorporating the Singapore flap and gracilis muscle flap into obstetric fistula repair

“…Since then, we have performed approaching 70 fistula repairs incorporating one or both flaps. We have been encouraged by the outcomes as these are the most complex fistulae to repair—quoted to have as low as a 52% success rate …”

Extended bladder catheterization for women with positive dye tests after obstetric vesicovaginal fistula repair surgery

“…In the authors’ anecdotal experience, most surgeons and patients would opt for extended catherization over a repeat surgery. For surgeons, repeat fistula surgeries are more challenging and have higher rates of failure of fistula breakdown compared to primary repairs . For patients, each hospitalization means less time providing for or taking care of family members.…”

“…For surgeons, repeat fistula surgeries are more challenging and have higher rates of failure of fistula breakdown compared to primary repairs. 6,9,10 For patients, each hospitalization means less time providing for or taking care of family members. When considering the higher risk of failure of repeat surgery and patient factor, it is reasonable to consider extended bladder catherization for patients.…”

Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

“…Our results are in line with the published rates of successful surgical closure of obstetric stula 80-97%. [11][12][13] In 10 women with RVF, with a very slim perineum, very poor tissue, narrow vagina and consequently being at a high risk of recurrence, or postoperative functional discomfort (e.g. vaginal stenosis, dyspareunia) and desiring another child, we recommended the stula repair in the context of a subsequent delivery.…”