Prevention of residual urinary incontinence following successful repair of obstetric vesico‐vaginal fistula using a fibro‐muscular sling

Browning, Andrew

doi:10.1111/j.1471-0528.2004.00080.x

Cited by 74 publications

(54 citation statements)

References 9 publications

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“…Among these determinants, fibrosis and urethral involvement have been identified by other authors [4] [9] [18], although some authors such as Barone [4] and Browing [19] do not recognize the importance of fistula size among the determinants of the success of the cure, however they agree on the size of the bladder, consequence of the size of the latter as an important element in this cure.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Outcomes and Prognosis Score in Obstetric Vesico-Vaginal Fistula Repair

Mubikayi¹,

Matson²,

Lokomba³

et al. 2017

OJOG

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An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p < 0.01), big fistula size (<0.01), small distance from fistula to external urethral meatus (<0.01) and prior surgery (p < 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. 768Conclusions: This study demonstrated that the marked vaginal scarring; large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.

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Section: Discussionmentioning

confidence: 99%

Determinants of Outcomes and Prognosis Score in Obstetric Vesico-Vaginal Fistula Repair

Mubikayi¹,

Matson²,

Lokomba³

et al. 2017

OJOG

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“…2,3 Few studies have investigated the nature of this residual incontinence urodynamically, those that have concluded that it is often stress urinary incontinence. 4 These women are a particularly difficult group to treat as they are present in areas of very limited medical resources and have a complicated, often poorly understood, pathology.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence is variably reported to affect between 8 and 33% of women after repair of their fistula. 1,2 A recent survey of 2000 patient notes in the Addis Ababa Fistula Hospital showed 26% of women suffering residual incontinence in the immediate postoperative period (E. Boyd and A. Browning, unpubl).…”

Section: Introductionmentioning

confidence: 99%

A new technique for the surgical management of urinary incontinence after obstetric fistula repair

Browning

2006

BJOG

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Obstetric vesicovaginal fistula is a debilitating injury still occurring widely throughout the developing world. Fortunately, now more and more surgeons are becoming aware of this previously hidden problem, and many thousands of women are receiving treatment each year. What is difficult for the fistula surgeon are those women, who after having their vesicovaginal fistula successfully closed, return to their doctor, still just as incontinent as they were with the fistula still open. This study describes a new, simple and cheap surgical procedure that promises to improve the lot of these unfortunate women.Keywords Fistula, incontinence, obstetric, surgery, urine.Please cite this paper as: Browning A. A new technique for the surgical management of urinary incontinence after obstetric fistula repair. BJOG 2006; 113:475-478.

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“…The fistulas were classified using the Waaldijk classification of vesico-vaginal fistula [4] ( Table 1). The examination consisted of a sterile speculum examination of the vagina, estimation of urethral length utilizing Foley catheter insertion, and estimation of bladder capacity using a graduated uterine sound in the bladder [5]. This technique, described by Waaldijk, utilized a graduated uterine sound to measure the distance between the urethral meatus and the bladder dome by subtracting the urethral length (centimeter distance from external urethral meatus to the inflated Foley balloon).…”

Section: Diagnostic and Surgical Techniquesmentioning

confidence: 99%

Surgical Approach to Obstetric Fistula Repair in Niamey, Niger: A Description of Surgical Technique

Erekson

Hampton²,

Idrissa³

et al. 2011

Gynecol Obstetric

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Objective: The objective of this project is to describe the diagnostic and surgical techniques utilized for the repair of complex obstetric vesico-vaginal fistula.Cases: The two cases described include a recurrent pinpoint fistula at the bladder neck and a primary fistula with traumatic amputation of the proximal urethra.Comment: Although most surgeons are unlikely to encounter the complexity of fistula caused by obstructed labor, principles used in the diagnosis and treatment of the complicated obstetric fistulas can guide surgeon approaching vesico-vaginal fistula repair of any etiology.

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Prevention of residual urinary incontinence following successful repair of obstetric vesico‐vaginal fistula using a fibro‐muscular sling

Cited by 74 publications

References 9 publications

Determinants of Outcomes and Prognosis Score in Obstetric Vesico-Vaginal Fistula Repair

Determinants of Outcomes and Prognosis Score in Obstetric Vesico-Vaginal Fistula Repair

A new technique for the surgical management of urinary incontinence after obstetric fistula repair

Surgical Approach to Obstetric Fistula Repair in Niamey, Niger: A Description of Surgical Technique

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