Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study.

Abstract

We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously. Prospective cohort study. Fistula Care Centre in Lilongwe, Malawi. Women who had undergone VVF repair in Lilongwe, Malawi at least 12months prior to enrolment. Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire. Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation. Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR=2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR=2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence. While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group. Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.