Risk factors that predict failure after vaginal repair of obstetric vesicovaginal fistulae

Nardos, Rahel; Browning, Andrew; Chen, Grace

doi:10.1016/j.ajog.2008.12.008

Cited by 78 publications

(82 citation statements)

References 8 publications

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“…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.…”

Section: Discussionsupporting

confidence: 53%

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

Bishinga

Zachariah

Hinderaker

et al. 2013

public health action

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Section: Discussionsupporting

confidence: 53%

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

Bishinga

Zachariah

Hinderaker

et al. 2013

public health action

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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: Discussionmentioning

confidence: 73%

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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“…The average age at onset of fistula was 25 years and the average length of time our patients had fistula was 8 years (4 months to 61 years) due to lack of availability of surgeons, 2 to 4 years for most authors around the world [5] [7] [9] [16] except Tegbeu who found 8.5 years in Cameroon. The duration of the index delivery labor that resulted in the formation of the obstetric fistula was 3 days as most authors have also noted in their series [9] [16] [17]. The average parity of these patients was 4 children per woman.…”

Section: Discussionmentioning

confidence: 77%

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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Risk factors that predict failure after vaginal repair of obstetric vesicovaginal fistulae

Cited by 78 publications

References 8 publications

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

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

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

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

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