Obstetric fistula: the use of urethral plugs for the management of persistent urinary incontinence following successful repair

Abstract

The objectives of this study are to analyse the effect of a urethral plug as a means of controlling persistent urinary incontinence following successful repair of an obstetric vesicovaginal fistula (VVF) and to identify factors which might influence potential success or failure. Data from Physiotherapy Department records of a series of 181 women referred for urethral plug assessment following successful repair of VVF were studied retrospectively. Outcome in terms of continence status with the plug was considered in relation to estimated bladder size, urethral length and diameter, and vaginal scarring. A total of 137 women (75.7 %) reported being dry whilst using a urethral plug and 18 (9.9 %) half dry. There were 26 women (14.4 %) who remained wet, 17 of whom had a new or wide urethra. A total of 101 women (55.8 %) had a smaller than normal estimated bladder size (linear measurement from urethral meatus to the deepest point of the bladder = <7.5 cm) and were more likely to remain wet although this was not found to be statistically significant. Adverse incidents included rupture of the urethral plug (two) and migration of a plug into the bladder, requiring cystoscopic removal (six) A urethral plug appears to be an effective means of restoring or improving continence in women with persistent urinary incontinence following successful repair of obstetric VVF although data on long-term outcome were not available for analysis. Success rates may be lower if women have a significantly reduced bladder capacity or a new or wide urethra.