Reintegration needs of young women following genitourinary fistula surgery in Uganda

Alice Emasu,Bonnie Ruder,L Lewis Wall,Godfrey Alia,Alphonsus Matovu,Justus Kafunjo Barageine

doi:10.1007/s00192-019-03896-y

Abstract

Introduction and hypothesisGenitourinary fistulas (usually arising following prolonged obstructed labor) are particularly devastating for women in low-income counties. Surgical repair is often difficult and delayed. While much attention has been devoted to technical surgical issues, the challenges of returning to normal personal, family, and community life after surgical treatment have received less scrutiny from researchers. We surveyed young Ugandan women recovering from genitourinary fistula surgery to assess their social reintegration needs following surgery.MethodsA cross-sectional survey of 61 young women aged 14–24 years was carried out 6 months postoperatively. Interviews were carried out in local languages using a standardized, interviewer-administered, semistructured questionnaire. Data were entered using EpiData and analyzed using SPSS.ResultsOngoing reintegration needs fell into interrelated medical, economic, and psychosocial domains. Although >90% of fistulas were closed successfully, more than half of women had medical comorbidities requiring ongoing treatment. Physical limitations, such as foot drop and pelvic muscle dysfunction impacted their ability to work and resume their marital relationships. Anxieties about living arrangements, income, physical strength, future fertility, spouse/partner fidelity and support, and possible economic exploitation were common. Sexual dysfunction after surgery—including dyspareunia, loss of libido, fear of intercourse, and anxieties about the outcome of future pregnancies—negatively impacted women’s relationships and self-esteem.ConclusionsYoung women recovering from genitourinary fistula surgery require individualized assessment of their social reintegration needs. Postoperative social reintegration services must be strengthened to do this effectively.

Highlights

Introduction and hypothesisGenitourinary fistulas are devastating for women in low-income counties
When genitourinary fistulas occur in high-income countries, they usually occur as a complication of surgery or cancer and its treatment [1, 2]
Most genitourinary fistulas in low-income lcountries like Uganda are caused by prolonged obstructed labor that results in compression of the vagina, bladder, and other soft tissues by the fetal head against the pubic bone, which leads to tissue necrosis, sloughing, and fistula formation [3, 4]

Summary

Introduction

Introduction and hypothesisGenitourinary fistulas (usually arising following prolonged obstructed labor) are devastating for women in low-income counties. Most genitourinary fistulas in low-income lcountries like Uganda are caused by prolonged obstructed labor that results in compression of the vagina, bladder, and other soft tissues by the fetal head against the pubic bone, which leads to tissue necrosis, sloughing, and fistula formation [3, 4]. Fistulas of this type can be prevented by early detection of obstructed labor and prompt intervention (cesarean delivery) to prevent the injury from progressing to

Methods

Results

Conclusion