Surgical outcome of obstetric fistula: a retrospective analysis of 595 patients

Sjøveian, Solbjørg; Vangen, Siri; Mukwege, Denis; Onsrud, Mathias

doi:10.1111/j.1600-0412.2011.01162.x

Cited by 54 publications

(53 citation statements)

References 15 publications

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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: 51%

“…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.…”

Section: Discussionmentioning

confidence: 46%

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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: 51%

Section: Discussionmentioning

confidence: 46%

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Zabin

Akhter

Sultana³

2016

Bangladesh J Obstet Gynaecol

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“…Amongst 597 patients operated for urogenital fistulae at Panzi hospital from November 2005 till November 2007, 21 fistulas (3.5%) were related to a previous hysterectomy (11,12). Nine of these women (42.9%) had a ureterovaginal fistula compared to 27 out of 567 women (4.8%) in the obstructed labor group (OR 15, 95%CI 5.8-38.7) ( Table 3).…”

Section: Data From the Democratic Republic Of Congomentioning

confidence: 99%

Urinary Tract Injuries in Low-Resource Settings

Onsrud¹

2012

Hysterectomy

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“…Previous study conducted in Ethiopia at YHFC on determinants of time to recovery from obstetric fistula surgery by taking one year's data didn't address all the peri-operative care related factors associated with Fistula recovery and further it was done in a setting with different socio demographic characteristic [26][27][28]. Therefore, it is necessary to conduct a research to estimate the time to recovery from obstetric fistula repair and associated factors that affect recovery.…”

Section: Problem Statementmentioning

confidence: 99%

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

Hailu¹

2018

J Preg Child Health

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Background: Ethiopia is one of the high fistula burdened countries in the world with an annual occurrence of 3,500 new and existence of 37,500 untreated obstetric fistula cases. Studies conducted in this area focus on determinants of obstetric fistula before surgical repair and researches addressing the associated factors are limited.Objective: To estimate time to recovery from a surgical repair of obstetric fistula and its associated factors among patients treated at Mekelle Hamlin Fistula Center. Results: The patients were followed for 6657 person days at risk, the median recovery time was 20 days. The overall recovery rate was 2.5 cases per 100 person days. Multivariable Cox proportional hazard model result showed labor duration of two or more days (AHR=0.73, 95% CI=0.53, 0.99) and post-operative bladder catheterization longer than 14 or more days (AHR=0.45, 95% CI=0.32, 0.62) were factors negatively associated with recovery time from obstetric fistula surgery. Methods Conclusion and recommendations:women who experienced labor of two or more days and post-operative bladder drainage for more than two or more weeks took longer time to recover after the repair. Therefore, Decision makers, Health care professionals, Stakeholders and Researchers should give emphasis on activities that reduce delays' in decision making, delays' in giving urgent intervention and delays' in reaching health institutions that contributes in reducing complications of prolonged labor ultimately obstetric fistula.Harmful traditional practices such as early marriage and home delivery are other potential factors for the development of obstetric fistula [8][9][10]. Globally, nine to 84% of obstetric fistula patients gave birth at home and more than 2 million women are currently living with this problem. Additional 50,000 to 100,000 new cases are estimated to occur each year and majority of which are from Africa and Asia [9][10][11][12][13].Incidence rates of obstetric fistula in countries with high maternal mortality is as high as two to three cases per 1000 women [14]. Estimated incidence and prevalence of untreated obstetric fistula in Ethiopia during the year 2010 was 3,500 and 37,500, respectively [9,15]. Introduction BackgroundObstetric fistula is an injury that occurs during prolonged or obstructed labor causing tissue damage to organs inside the pelvis and resulting in incontinence of urine, feces or both. The dead tissues due to prolonged pressure fall away and a hole will be formed between the vagina and bladder called Vesico-vaginal Fistula (VVF) or between the vagina and rectum called Recto Vaginal Fistula (RVF) [1][2][3].Obstetric fistula is the worst child birth related complication that contributes for 2.5% of the Global daily death of mothers associated with child birth related complications [4].The main causes of obstetric fistula in the developed world are radiation therapy and surgery whereas in developing countries, "the three delays" are responsible, the delay in seeking skilled emergency obstetric care, the del...

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Surgical outcome of obstetric fistula: a retrospective analysis of 595 patients

Abstract: Fistula in Democratic Republic of Congo was found in both primiparous and multiparous women, indicating a need for increased access to obstetric care for all pregnant women. Fistulas repaired for the first time, with no fibrosis and size <2 cm, had the best surgical outcome.

Cited by 54 publications

References 15 publications

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Urinary Tract Injuries in Low-Resource Settings

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

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