Obstetric vesico-vaginal fistulas: Midvaginal and juxtacervical fistula repair outcomes in the Democratic Republic of Congo.

Abstract

This study aims to establish the postoperative success rates of midvaginal versus juxtacervical obstetric vesicovaginal fistula (VVF) repairs. In addition, we aim to quantify the impact of patient sociodemographic variables, fistula classification, and surgical repair techniques associated with postoperative outcomes. A retrospective cohort study was conducted involving 420 women who had undergone a primary obstetric VVF repair. All data were collected from the Panzi Hospital, Democratic Republic of Congo between 2015 and 2017. Patient notes were analyzed to determine sociodemographic variables, symptoms, fistula classification, surgical repair techniques, and postoperative follow up. Binary logistic regression presented as χ2 for trend was used to establish P values. Overall, 95.6% and 96.2% of midvaginal and juxtacervical VVF, respectively, underwent a successful repair. The principal prognostic factor associated with a statistically significant likelihood of a successful repair was the degree of fibrosis noted preoperatively (P=0.004, 95% confidence interval [CI] 2.38-94.61). Furthermore, VVF were more likely to have a successful repair if they were closed in two layers (P=0.004, 95% CI 1.86-25.81) and sutured vertically (P=0.005, 95% CI 1.16-2.52). Overall, high postoperative success rates of obstetric VVF repair can be expected among well-trained surgeons but a complex interplay of factors means that the ability to preoperatively foreshadow individual outcomes remains difficult.