Abstract
BackgroundObstetric fistula although virtually eliminated in high income countries, still remains a prevalent and debilitating condition in many parts of the developing world. It occurs in areas where access to care at childbirth is limited, or of poor quality and where few hospitals offer the necessary corrective surgery.MethodsThis was a prospective observational study where all women who attended Mbarara Regional Referral Hospital in western Uganda with obstetric fistula during the study period were assessed pre-operatively for social demographics, fistula characteristics, classification and outcomes after surgery. Assessment for fistula closure and stress incontinence after surgery was done using a dye test before dischargeResultsOf the 77 women who were recruited in this study, 60 (77.9%) had successful closure of their fistulae. Unsuccessful fistula closure was significantly associated with large fistula size (Odds Ratio 6 95% Confidential interval 1.46-24.63), circumferential fistulae (Odds ratio 9.33 95% Confidential interval 2.23-39.12) and moderate to severe vaginal scarring (Odds ratio 12.24 95% Confidential interval 1.52-98.30). Vaginal scarring was the only factor independently associated with unsuccessful fistula repair (Odds ratio 10 95% confidential interval 1.12-100.57). Residual stress incontinence after successful fistula closure was associated with type IIb fistulae (Odds ratio 5.56 95% Confidential interval 1.34-23.02), circumferential fistulae (Odds ratio 10.5 95% Confidential interval 1.39-79.13) and previous unsuccessful fistula repair (Odds ratio 4.8 95% Confidential interval 1.27-18.11). Independent predictors for residual stress incontinence after successful fistula closure were urethral involvement (Odds Ratio 4.024 95% Confidential interval 2.77-5.83) and previous unsuccessful fistula repair (Odds ratio 38.69 95% Confidential interval 2.13-703.88).ConclusionsThis study demonstrated that large fistula size, circumferential fistulae and marked vaginal scarring are predictors for unsuccessful fistula repair while predictors for residual stress incontinence after successful fistula closure were urethral involvement, circumferential fistulae and previous unsuccessful fistula repair.
Highlights
Obstetric fistula virtually eliminated in high income countries, still remains a prevalent and debilitating condition in many parts of the developing world
We considered a successful repair with continence if a women was are dry following fistula surgery after 14-21 days of continuous bladder drainage, successful repair with incontinence if a women was wet of urine on stress but had a negative dye test after catheter removal and Failure or Unsuccessful closure if a women was wet of urine and had a positive dye test after 14-21 days of continuous bladder drainage following fistula
Obstetric fistula was more common in primiparous patients, especially those coming from the rural areas
Summary
Obstetric fistula virtually eliminated in high income countries, still remains a prevalent and debilitating condition in many parts of the developing world. The urethrovesical junction is affected in most cases but any other site along the genital tract may be involved like the bladder base, urethra with partial or complete urethral loss and detachment (circumferential fistula), extensive anterior vaginal wall loss or just beside the cervix (juxtacervical fistula). With this prolonged obstruction, the fetus dies in about 95% of cases, the head softens and a stillbirth is delivered if the mother manages to survive [4]. Type II is further subdivided into IIa and IIb depending on presence or absence of urethral involvement), Type III fistulae denote any others like ureteric and intracervical fistulae [5]
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