Predicting the risk of failure of closure of obstetric fistula and residual urinary incontinence using a classification system

Abstract

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.

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

“…A number of papers have described surgical interventions, but often with much less success than that enjoyed in women without fistulas. [4][5][6][7] We found, as others have 8,9 no relationship between fistula size and successful closure after repair surgery. It is plausible that fistula size, independent of other factors, is not a predictor of repair outcome because even large defects can be surgically closed, whereas other factors such as prior repair or severe scarring (that may reduce the amount of viable tissue), or urethral involvement (that may affect sphincter mechanisms), cannot be easily addressed surgically.…”

“…7,9-12 Our results provide further evidence supporting the role of vaginal scarring and urethral involvement in predicting failure to close the fistula and residual incontinence following fistula closure. 5,7,8,10,12,13 They also support the smaller number of studies suggesting a negative prognostic role of bladder size and prior repair .6,7,12,13 So risk factors identified were involvement of the urethra, a small functional bladder capacity, increasing diameter of the fistula and the need for vaginal reconstruction. It is interesting to note that delivery method seemed protective for developing residual incontinence after fistula repair.…”

High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward?

“…First, the conventional approach until now has been to report fi stula treatment outcomes at the time of hospital discharge only, and not beyond this time. Such outcomes are generally reported to be good, with fi stula closure rates of 73-93% reported from various other African settings, [13][14][15][16][17] compared to 87% in our setting. However, repair breakdowns are known to occur in the 6-month post-operative period, 8 invalidating these hospital discharge outcomes.…”

Genitourinary Fistula: An Indian Perspective

“…Usually the initial practice is to provide proper bladder drainage with antibiotics. Its success has been reported in a small number of cases of small fistula after iatrogenic injury with the prolong catheterization (range from 19 to 54 days) [10]. None of our cases show the healing of fistula after 1 month of catheterization.…”