Risk factors for developing residual urinary incontinence after obstetric fistula repair

Browning, Andrew

doi:10.1111/j.1471-0528.2006.00875.x

Cited by 99 publications

(76 citation statements)

References 6 publications

(7 reference statements)

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“…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.…”

Section: Discussionsupporting

confidence: 52%

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Zabin

Akhter

Sultana³

2016

Bangladesh J Obstet Gynaecol

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Introduction:Obstetric fistula surgery presents many challenges. The injury usually occurs in resource-poor areas and is thus managed in hospitals that are themselves poorly resourced. The pathology is complex and extensive, affecting any and sometimes all parts of the lower urinary tract. The long obstructed labour and resulting ischemia throughout the pelvis can destroy all the normal mechanisms for urinary continence. 1 It is one thing to be able to close the defect and try to restore normal anatomy, but it is quite another thing altogether to obtain a functional closure, ensuring normal continence. There are varied reports about the extent of incontinence after fistula surgery, from 8% 1 to more widely accepted figures of 18-33%, 2 even up to 47% in an unpublished survey performed in the Addis Ababa Fistula Hospital in 2003. As with all things, it depends on how closely a fistula surgeon look for the problem. In the early work by Kelly and Kwast, 1 the figure was the number of women returning to the hospital with continuing incontinence despite a closed fistula. It is likely that many women would have remained at home with mild incontinence. The figures of 18-33% had accepted way of looking for incontinence including a basic set of structured questions ranging from'are you wet with cough or heavy activity? 'are you leaking urine involuntarily when lying?. 2 A cough examination with a full bladder was used to confirm the diagnosis.The exact nature of the incontinence is often complex and only a handful of studies have investigated the nature of the pathology. One study 3 of 22 women with severe incontinence following fistula closure underwent urodynamic assessment: 41% had genuine stress incontinence (GSI); 14% had GSI and poor Residual urinary Incontinence after SuccessfulRepair of Obstetric Fistula

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Section: Discussionsupporting

confidence: 52%

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Zabin

Akhter

Sultana³

2016

Bangladesh J Obstet Gynaecol

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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: 92%

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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“…Among these techniques, we performed colposuspension (25 cases), described by Waaldijk [6]. Although these techniques seem to produce interesting results, it is difficult to draw conclusions from this because of the difficult follow-up of patients over a long term [18] [19]. Moreover, the high cost of synthetic strips makes it impossible to afford them in developing countries [18].…”

Section: Therapeutic Characteristicsmentioning

confidence: 99%

Results of the Management of Urogenital Fistulae from Community Caravans

Bohoussou¹,

Dia²,

Okon³

et al. 2017

OJOG

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Objective: To report the experience of surgical caravans for urogenital fistulas care. Methodology: This was a retrospective study covering the period from January 2014 to December 2014 and which took place on 7 sites of fistula care. The epidemiological, anatomoclinical, therapeutic and evolutionary aspects were studied. Results: 346 patients were operated during 14 caravans. Their average age was 33.11 years (range: 12 to 70 years). Most of these patients were without remunerative activities (80%) and without education (63.3%). The average duration of fistula progression was 6.08 years (range: 0 to 42 years). Obstetrical etiology was predominant (87.9%). According to the classification of Kees Waaldijk, fistulas were divided into type I (67.4%), type II (21.1%), and type III (11.5%). The most common surgical approach was the transvaginal route (82.1%). The vesicovaginal splitting with separated suture of the bladder and the vagina was the basic technique (94.7%). The therapeutic results were judged after a follow-up of 1 month and 3 months. Across the cohort, 80 patients (23.1%) were lost of sight for follow-up at 1 month and 245 (70%) at 3 months. The success rates evaluated in patients reviewed at 1 month and 3 months were respectively 70% and 64%. Conclusion: The incidence of urogenital fistulas is still high in Côte d'Ivoire. Various anatomoclinical varieties have been identified and treated with satisfactory results in poorly equipped local structures.

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Risk factors for developing residual urinary incontinence after obstetric fistula repair

Cited by 99 publications

References 6 publications

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

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

Results of the Management of Urogenital Fistulae from Community Caravans

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