Abstract
Urethral incontinence is an issue for approximately 10–15% of women with an obstetric fistula. Various surgical interventions to prevent this exist, including the pubococcygeal sling and refixation of the pubocervical fascia. Neither has been evaluated in comparison to one another. Therefore, this retrospective evaluation for superiority was performed. The primary outcome was urinary stress incontinence, and secondary outcomes were operative factors. There were 185 PC slings, but 12 were excluded because of urethral plications. There were 50 RPCF procedures, but 3 were excluded because of urethral plications. Finally, there were 32 cases with both PC sling and RPCF procedures. All groups demonstrated a higher than expected fistula repair rate with negative dye tests in 84% of the PC sling group, 89.9% in the RPCF group, and 93.8% in the RPCF and PC groups. There were no statistically significant differences found in continence status between the three groups. Of those who underwent PC slings, 49% were found to have residual stress incontinence. Of those who underwent RPCF, 47.8% had stress incontinence. Of those with both techniques, 43.8% had residual stress incontinence. Pad weight was not significantly different between the groups. As there is no statistically significant difference, we cannot recommend one procedure over the other as an anti-incontinence procedure. The use of both simultaneously is worth investigating.
Highlights
Residual urinary incontinence is a challenge in obstetric fistula surgery
There were 32 cases with both PC sling and refixation of the pubocervical fascia (RPCF) procedures. erefore, the PC and RPCF combination arm was underpowered to detect a significant difference between the groups
All groups demonstrated a higher than expected fistula repair rate given the higher complexity of those undergoing RPCF and/or PC sling, with negative dye tests in 84% of the PC sling group, 89.9% in the RPCF group, and 93.8% in the RPCF and PC group (Table 1). ere is a trend towards negative dye tests with the combination of the RPCF and PC
Summary
Residual urinary incontinence is a challenge in obstetric fistula surgery. Despite the successful closure of the vesicovaginal fistula, the urethra no longer functions properly. Many patients leak so severely that they do not consider themselves healed [1, 2]. Browning describes a fibromuscular vaginal sling using the pubococcygeal (PC) muscle with significant reduction in residual incontinence (Figure 1) [3]. He documents a stress incontinence rate of 39% (n 272) compared to a previous rate without the sling for high-risk patients of 55% [4]. No other author has documented their residual incontinence rate when incorporating the PC sling or compared it to another technique
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