Fistula In Patients Research Articles

A rare case of pancreaticopleural fistula patient presented in surgery OPD

Pancreatico-pleural fistula is rare and infrequent complication of commonly occurring chronic pancreatitis leading to an extra-peritoneal abnormal connection between the pancreatic system and pleural cavity. Diagnosis needs high-level clinical suspicion to avoid delay in the diagnosis as the patient presents with respiratory distress rather than any abdominal symptom and produces large quantities of pleural fluid intractable of pleural tapping or chest drain. Diagnosis of the fistula is clicked by elevated pleural fluid amylase. Various imaging options are available with their unique importance like CECT, ERCP and MRCP. In a low resource, setup CECT becomes a useful modality to delineate the pancreatic parenchymal changes, pancreatic duct anatomy and fluid collection, thus aid in the diagnosis. Treatment modalities depending on structural anatomy of the duct and parenchymal destruction are either Medical, Conservative and Surgical. Here our patient presented with massive left sided pleural effusion resistant to surgical intervention secondary to chronic pancreatitis in a 28-year man later diagnosed as Pancreatico-pleural fistula on CECT. The patient underwent distal pancreatectomy with splenectomy with decortication of the lung with excision of PPF. The patient now is continuous follow-up for chronic pancreatitis and is symptom-free from last 2 years.

Differences in amino acid and lipid metabolism distinguish Crohn's from idiopathic/cryptoglandular perianal fistulas by tissue metabonomic profiling and may offer clues to underlying pathogenesis.

Few studies have investigated perianal fistula etiopathogenesis, and although the cryptoglandular theory is widely accepted in idiopathic cases, in Crohn's disease, it is thought to involve the interplay between microbiological, immunological and genetic factors. A pilot study was conducted to assess for metabolic variations in Crohn's perianal fistula tissue that might differ from that of idiopathic (cryptoglandular) perianal fistula tissue as a comparator. The goal was to identify any potential biomarkers of disease, which may improve the understanding of pathogenesis. Fistula tract biopsies were obtained from 30 patients with idiopathic perianal fistula and 20 patients with Crohn's anal fistula. Two different assays were used in an ultra-high-performance liquid chromatography system coupled with a mass spectrometric detector to achieve broad metabolome coverage. Univariate and multivariate statistical data analyses were used to identify differentiating metabolic features corresponding to the perianal fistula phenotype (i.e. Crohn's disease vs. idiopathic). Significant orthogonal partial least squares discriminant analysis predictive models (validated with cross-validated-analysis of variance P value <0.05) differentiated metabolites from tissue samples from Crohn's vs. idiopathic anal fistula patients using both metabolic profiling platforms. A total of 41 metabolites were identified, suggesting alterations in pathways, including amino acid, carnitine and lipid metabolism. Metabonomics may reveal biomarkers of Crohn's perianal fistula. Further work in larger numbers is required to validate the findings of these studies as well as cross-correlation with microbiome work to better understand the impact of host-gut/environment interactions in the pathophysiology of Crohn's and idiopathic perianal fistulas and identify novel therapeutic targets.

Comparative study between conventional fistulectomy and SLOFT in cases of low fistula in ano

Introduction: Fistula in ano is a common anorectal disorder requiring surgical intervention. It is associated with high recurrence rate and post-operative complications. In this study we have analysed and compare results of a newer technique for low anal fistula SLOFT with conventional Fistulectomy. Aims and Objective: To compare Submucosal Ligation of Fistula Tract (SLOFT) with conventional fistulectomy in patients of low anal fistula by analysing various intra-operative factors and post-operative outcome. Materials and Methods: An interventional study carried out at Santosh Medical College and Hospitals, Ghaziabad from January 2017 to October 2018. This study included 60 Patients of low anal fistula which were divided into two groups of 30 patients each. Group I was offered Conventional Fistulectomy & Group II underwent SLOFT. Result and Observations: Fistula in ano is commonly seen in middle aged males. There is no significant difference in duration of surgery between SLOFT and Fistulectomy. However post-operative complications, pain (measured by VAS scoring system), wound healing and early return to work was significantly better in patients who underwent SLOFT. Conclusion: SLOFT has significant advantage over convention fistulectomy in terms of post-operative pain, wound healing, early return to work and cosmetic outcome. Keywords: Fistula in ano, Low anal fistula, SLOFT (Submucosal ligation of fistula tract), LIFT (Ligation of intersphincteric fistula tract), Fistulectomy.

Impact of the various factors on survival of tracheoesophageal fistula patients: A prospective study of 16 patients

Introduction: Tracheoesophageal fistula (TEF) is one of the common congenital anomalies presented at birth. Management of TEF is a challenging task as outcome of these cases not only depends on surgeon and anaesthesiologist’s skills but also depends on various factors associated with new born. This prospective study evaluates the association of various factors on survival of TEF patients. Materials and Methods: 16 newborn patients in a calendar year were enrolled in this prospective study and impact of various factors like age, weight, parity of mother, associated congenital anomalies and family history, mode of delivery, place of delivery, associated hydramnios and type of TEF were evaluated on the survival of neonates born with TEF. Results: Male, female ratio was equal. Patient with birth weight >2.5 kg had higher survival rate (100%) compared to patient Conclusion: Birth weight remains the single most important predictor of mortality among TEF patients, as suggested with Waterston risk classification. Keywords: Tracheoesophageal fistula, Birth weight, Neonates, Waterston classification.

Socio-demographic Characteristics of Vesico-vaginal fistula (VVF) patients attended at a tertiary Care Hospital in Bangladesh

Background: Vesico-vaginal fistula can occur in different women with varied socio-economic condition.&#x0D; Objectives: The purpose of the present study was to see the socio-demographic characteristics of vesico-vaginal fistula (VVF) patients attended at a tertiary care hospital in Bangladesh.&#x0D; Methodology: This cross-sectional study was carried out from July 2013 to December 2013 for a period of 6 months in the National Fistula Centre in the Department of Obstetrics &amp; Gynaecology at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. All patients who underwent surgical repair for iatrogenic VVF in National Fistula Centre of the department of Obstetrics and Gynaecology of Dhaka Medical College Hospital were included in this study. Patients who got themselves admitted to Obstetrics &amp; Gynaecology department of DMCH with the complaints of fistula. The entire selected patients were interviewed for detailed socio-demographic characteristics.&#x0D; Result: A total number of 51 cases of VVF were recruited for this study. The mean age was 46.02 (±SD 6.104) years. Most of the respondents were illiterate (55.0%) and one-third patients had primary level education. The number of highly educated patients was scarce (12.0%). It was evident that average age at marriage of the patients was 15.8(±4.74) years. Some females were forced to accept marriage at the age of 10 years. The mean interval between initiation of menstruation and the marriage was only 4.72 years. Mothers were on an average 17.48 years old at the time of first delivery.&#x0D; Conclusion: In conclusion middle age illiterate women are most commonly suffering from VVF.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 114-117

Provider Perspectives on Persistent Urinary Incontinence Following Obstetric Fistula Repair in Ethiopia.

Each year an estimated 50,000 to 100,000 women worldwide are affected by obstetric fistula. This devastating but preventable maternal morbidity leaves women incontinent, stigmatized, isolated, and often with a still birth. While fistula rates in Ethiopia have declined in recent years, estimates range from 7 to 40 percent of women suffer from persistent urinary incontinence after successful closure of their fistula. Few studies have focused on the unique experiences and challenges that providers face treating fistula patients, particularly those who experience persistent urinary incontinence. The goal of this research is to characterize the fistula provider's accounts of how to manage, support, and understand their patient's experience. Semi-structured interviews were conducted with a purposive sample of fistula care providers in Mekelle and Addis Ababa, Ethiopia. The main themes that emerged were a perceived exacerbated impact on quality of life for women with persistent urinary incontinence; a “double hit” of isolation from both their community and from other recovered fistula patients; how the church both influences how patients internalize their injury and provides them with hope and support; and the need for comprehensive and compassionate fistula care. Understanding how providers perceive and relate to their patients provides valuable insight to the unique challenges of treating this population and may better inform treatment programmes to address the gap between patient needs and current fistula care models.

Socio-Cultural Problems of Urinary Fistula Patients Admitted at Dhaka Medical College and Hospital, Bangladesh

Socio-Cultural Problems of Urinary Fistula Patients Admitted at Dhaka Medical College and Hospital, Bangladesh

The relational dynamics of women with obstetric fistula in Africa: a narrative review

Background/Aims Obstetric fistula has profound psychological effects on women and influences how they are treated by their family members. This study aimed to identify the relational dynamics of women that had experienced fistula through a narrative review, and determine the extent to which treatment recommendations in the studies reviewed targeted the identified dynamics. Methods This study was a narrative review using a systematic approach, which analysed treatment and care of obstetric fistula patients in Africa. The search was conducted between January and May 2020 for studies published in English between 2006 and 2020. The search used five electronic journal databases: BioMed, SAGE, ScienceDirect, Taylor and Francis Online and Wiley Online. Results Obstetric fistula commonly resulted in unhealthy relational dynamics that had negative effects both on women and their family systems. Despite these findings, most studies did not recommend interventions specific to the family systems of the women. Conclusions It is important to expand the focus of obstetric fistula treatment from an individual to a systemic level. Increased collaboration between mental health practitioners and medical staff in the treatment of obstetric fistula is needed, in order to improve quality of care.

Evaluating postoperative anal fistula prognosis by diffusion-weighted MRI

PurposeThe purpose of this study was to explore whether preoperative diffusion-weighted magnetic resonance imaging (DW-MRI) can be used to evaluate the prognosis of anal fistula and identify the influence factors of postoperative recurrence. MethodsThis is a retrospective study of 117 patients with anal fistula who have undergone preoperative DW-MRI and surgery. All patients were followed up by telephone or reexamination within 2 years after surgery. Of the 117 patients, 35 were excluded due to loss of follow-up and only 82 were included in this study. MRI fistula imaging-related data were analyzed, and fistula severity was scored using criteria of both local extension of fistulas and active inflammation for a total maximum score of 22. The apparent diffusion coefficient (ADC) value of the fistula in patients with anal fistula during preoperative MRI examination was measured. According to whether anal fistula patients are accompanied by perianal abscess, they are divided into two groups, namely anal fistula group and anal fistula with abscess group. Based on whether patients with anal fistula recur after surgery, they were further divided into recurrent group and non-recurrent group. Results82 patients with anal fistula were included in this analysis, 23 of them recurred and 59 were cured. Among patients with perianal abscess, the mean ADC value of the recurrent group was (1.19 ± 0.21)×10−3 mm2/s, which is significantly lower than that of the non-recurrent group (1.36 ± 0.19)×10−3 mm2/s. There were significant statistical differences in ADC values between the two groups (p = 0.03). Among patients with anal fistulas without abscesses, 15 patients recurred after surgery, with a mean ADC value of (1.45 ± 0.27) ×10-3 mm2/s, and 33 patients didn’t occur, with a mean ADC value of (1.44 ± 0.31)×10−3 mm2/s. The ADC value of preoperative fistula in patients was negative significant correlation with MRI findings score (r= -0.332, P = 0.002). Risk factors for the recurrence after anal fistula surgery include the time interval between MRI and operation, multiple fistula tracks. Fatigue, excessive intake of spicy or greasy food and diarrhea may also be external risk factors for postoperative recurrence of patients with anal fistula. ConclusionsDW-MRI has important application value for the prognosis evaluation of anal fistula. Complex type of anal fistula and improper lifestyle are the main risk factors affecting the recurrence after anal fistula surgery.

Assessing validity of existing fistula-in-ano classifications in a cohort of 848 operated and MRI-assessed anal fistula patients – Cohort study

Aim/backgroundThe commonly used fistula-in-ano classifications, Park or St. James's University hospital(SJUH), neither grade fistulas as per their severity nor guide regarding their management. A new classification(NC), published in 2017, proposed to classify fistulas as per their severity and also guided in its management. The early grades (NC grade I & II) were simple fistulas and were amenable to fistulotomy whereas higher grades (NC grade III-V) were complex fistulas and were not amenable to fistulotomy. MethodsLower grades of all the three classifications were classified as simple (Parks: I, SJUH:I-II, NC:I-II) whereas higher grades were classified as complex (Parks: II-IV, SJUH: III-V, NC: III-V) fistulas. Fistulotomy should be possible in simple fistulas but not in complex fistulas. This was analysed for all these classifications. The long-term follow-up of continence was done by an objective scoring system (Vaizey's scores). ResultsThe SJUH & Parks classifications categorized 504/828 fistulas as ‘complex’ which was quite inaccurate as 42.7%(215/504) of these fistulas were safely amenable to fistulotomy. On the other hand, the New classification (NC) classified 282/828 fistulas as ‘complex’ which was very accurate as 99% (279/282) of these were actually complex and were not amenable to fistulotomy. The change in the preoperative and the postoperative continence scores in the patients who underwent fistulotomy, as per these classifications, Parks & SJUH vs NC, was 0.064 ± 0.62 and 0.089 ± 0.85 respectively and was not significantly different(p = 0.80, Mann-Whitney U test). ConclusionsThe New classification(NC) seems better than the existing classifications for grading the disease as well as in guiding the management of the disease.

Perioperative Opioid and Nonopioid Prescribing Patterns in AVF/AVG Creation

To evaluate postoperative opioid prescribing patterns in patients undergoing hemodialysis access creation. Operative logs were reviewed to identify patients undergoing creation of arteriovenous fistula (AVF) or graft (AVG) from September 2016 to January 2018. Immediate postoperative opioid prescriptions were compared for ambulatory patients versus inpatients. Opioid prescriptions at the time of discharge for inpatients were recorded. Rates of opioid prescribing were standardized by conversion to morphine milligram equivalents (MMEs). Opioid use postoperatively and at the time of discharge based on anesthetic technique, general anesthesia versus regional or local anesthesia with sedation were compared. Alternative pain medications administered and pain scores were recorded. Comparisons were made between the percentage of opioid use and doses administered between AVF and AVG patient groups, ambulatory and inpatients, and type of anesthetic technique used. Statistical analysis was performed with chi-square and t-tests. We identified 164 patients undergoing AV access creation but not receiving chronic opioid therapy. A significantly higher percentage of inpatients received opioids in the immediate postoperative period than ambulatory patients (AVF: 72% vs. 19%, P<0.001; AVG: 62% vs. 25%, P=0.001). Overall, all AVG patients were more likely to be discharged with an opioid prescription than all AVF patients (37% vs. 8%, P<0.001). Of AVG patients managed in the ambulatory setting, 48% were discharged with an opioid prescription. The mean total opioid postoperative dose prescribed to inpatients was significantly higher than that prescribed to ambulatory patients for both fistulas (28.73 MMEs vs. 1.27 MMEs, P<0.001) and grafts (22.11 MMEs vs. 2.16 MMEs, P=0.005). General anesthesia patient groups were more likely to receive opioids postoperatively than local anesthesia with sedation patients for both AVF (54% vs. 24%, P=0.027) and AVG creation (61% vs. 17% P<0.001). Postoperative alternative medication use in the hospital was low with 18% acetaminophen and 1% nonsteroidal anti-inflammatory drug use for AVF patient groups and 24% acetaminophen and 0% nonsteroidal anti-inflammatory drug use for AVG patient groups. The percentage of patients reporting postoperative pain in the recovery room and on the inpatient units was comparable between ambulatory and inpatient settings (AVF: 21% vs. 28%, P=0.534; AVG: 23% vs. 44%, P=0.061). A higher percentage of inpatients undergoing hemodialysis access received opioids when compared with ambulatory patients in the immediate postoperative period. Inpatients were prescribed higher mean doses than ambulatory patients. AVG patient groups were prescribed more opioids than AVF patient groups. Alternative analgesic agent use was low, suggesting an opportunity for improved pain control and opioid reduction. Dialysis access creation represents an opportunity to improve on opioid prescribing patterns.

Integrated mental health screening for obstetric fistula patients in Mali: From evidence to policy.

BackgroundObstetric fistula significantly impacts women’s mental health and well-being. Routine screening for mental health in fistula repair programs can be a gateway to link patients to services, and can produce routine data to inform programmatic investments. This study observed the integration of a mental health screening program into an obstetric fistula repair program in Mali, with two specific objectives: 1) to describe the social and mental health well-being of women presenting with obstetric fistulas in Mali, and 2) to document the impact of the mental health screening pilot on policy change in Mali.MethodsSeven fistula repair campaigns were conducted between June 2016 and May 2017. All individuals presenting for fistula repair completed a mental health assessment at intake, including a depression screener (PHQ-9) and an assessment of psycho-social impacts of fistula. The depression screener was repeated three months following inpatient discharge. Findings were shared with stakeholders in Mali and impacts on policy were documented.ResultsOf 207 women who presented for fistula repair, 167 patients completed the mental health assessment at surgical intake, and 130 patients repeated the screener at 3-month follow-up. At intake, 36.5% of women had moderate or severe depression, decreasing to 16.9% at follow-up. The mean depression score differed significantly by timepoint (9.14 vs. 6.72, p <0.001). Results were shared in a report with stakeholders, and consultations with the Mali Ministry of Health. As a result of advocacy, mental health was a key component of Mali’s National Fistula Prevention and Treatment Strategy (2018–2022).ConclusionThe high prevalence of depression in Malian fistula patients underscores a need for more robust mental health support for patients after surgery. Data on mental health from routine screening informs community reintegration strategies for individual patients, elevates the overall quality of care of fistula repair programs by addressing patients’ holistic health needs, and contributes to evidence-informed decision-making and data-driven policy change within the larger health system.

Comparision of Preoperative Mri Findings with Intraoperative Findings in Patient of Fistula in ANO

MRI has become the method of choice for evaluating perianal fistulae due to its ability to display theanatomy of the sphincter muscles orthogonally, with good contrast resolution. In this article we compareMRI findings to intraoperative findings in patients of Fistula in Ano. This study is based on a retrospectiveanalysis of 35 patients with a clinical diagnosis of perianal fistula

Urogynecology

Urogynecology

The outcome of two stage repair in anorectal malformations with rectovestibular fistula.

Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material &amp; Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.

Endourological Management of Iatrogenic Ureterovaginal Fistula following Obstetric and Gynecological Surgeries at Tertiary Referral Center

Aims: To evaluate the outcome of endourological management of iatrogenic ureterovaginal fistula caused by gynecological and obstetric surgeries.&#x0D; Methods: This is a retrospective analysis of uretorovaginal fistula (UVF) patients who underwent UVF management with endourology technique from February 2014 to November 2019. All data were taken from fistula database. All non-obstetric/gynaecological cases and open surgical procedures leading to UVF were excluded. Diagnostic evaluation by cystoscopy and ureterorenoscopy; and use of guide wire, C-arm and DJ stent were recorded. Three to six months post-operative follow up status was also recorded.&#x0D; Results: There were 14 cases managed by retrograde DJ stenting. Both hysterectomy (n=10) and Cesarean Sections (n=4) were the past surgeries. Diagnosis was made by history, methylene blue test, cystoscopy, intravenous urography and CT urogram. Treatment was retrograde DJ stenting. All of them had unilateral distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. All were continent at the end.&#x0D; Conclusions: Endourological approach with retrograde DJ stenting had successful outcome in iatrogenic UVF.&#x0D; Keywords: double J stent, endourological technique, iatrogenic ureterovaginal fistula, ureterorenoscope.

Perceived Causes of Obstetric Fistula and Predictors of Treatment Seeking among Ugandan Women: Insights from Qualitative Research.

Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uga nda. We explored women's perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June-August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and children. Barriers to early treatment seeking included inadequate financial and social support, erroneous perceptions about fistula causes and curability, incorrect diagnoses, and delayed or lack of care at health facilities. Our study supports broad educational and awareness activities, facilitation of social and financial support for accessing care, and improving the quality of emergency obstetric care and fistula treatment surgical capacity to reduce women's suffering.

Quality of Life among Obstetric Fistula Patients at Kitovu Mission Hospital: A Health Facility-Based Cross-Sectional Study in Masaka District, Uganda.

Background Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman's quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda. Method A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis. Results Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (P < 0.001), employment status (P < 0.001), energy for everyday life (P < 0.001), capacity to work (P < 0.001), satisfaction with personal relationships (P < 0.001), feelings of loneliness (P < 0.001), negative feelings (P = 0.002), and self-confidence (P < 0.001) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019–517.467), formal education (OR = 9.9497; CI = 1.075–92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149–2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447–74.824). Conclusion A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.

The levels of self-efficacy among obstetric fistula patients in different repair categories at St. Joseph Kitovu Hospital, Uganda. A cross-sectional survey

Objective: The repair of obstetric fistula is possible and potentially addresses the physical ordeals, but the psycho-social afflictions with effect on patients’ self-efficacy may persist. Meanwhile, inadequate evidence exists regarding the levels of self-efficacy among patients in different repair categories, which incited this study. Methods: Data was collected and analyzed among the 402 participants at St. Joseph Kitovu Hospital Masaka, Uganda. 390 participants were involved in quantitative methods while 22 were involved in qualitative methods. Only obstetric fistula patients were involved in the quantitative study, 10 of them in a qualitative study. The other 12 were key informants who were included purposively. The patients were identified from the Urogynecology department surgical logbook, randomly sampled using SPSS 25.0, invited by phone calls and others identified through snowballing. Results: Among the patients, 192 had had repair of the fistula, of which 82.3% had been successful while 198 had not yet had fistula repair. The largest proportion (47.0%) was aged 19 to 29 years. The levels of self-efficacy among the patients included low, moderate and high. The larger proportion (60.26%) had a moderate level, 20.00% had a high level while 19.74% had a low level of self-efficacy. However, when Pearson correlation was done, the patients whose fistula had been repaired had a higher level of self-efficacy compared to those with unrepaired fistula with all the attributes of self-efficacy having P-values of &lt;0.001 at a significant level of 0.05. Interviewees also reported that patients with repaired fistula generally have higher levels of self-efficacy compared to those whose fistulas are not yet repaired. Conclusion: Obstetric fistula patients may have low, moderate or higher levels of self-efficacy depending on the level of incontinence, repair status, and prior training in life skills. Therefore, targeted strategies aimed to reduce incontinence and promote wellbeing such as the repair of fistula, life skills training and counseling would improve the levels of self-efficacy henceforth enhance social rehabilitation and reintegration.

The Relationship Between Self-fulfilling Prophecies and Social Reintegration Among Obstetric Fistula Patients in Different Repair Categories at St. Joseph Kitovu Hospital, Uganda

Background: Obstetric fistula is a debilitating childbirth injury. Patients live in despair and self-stigmatize. Studies highlight beliefs and perceptions about the cause of the disease and how it can be cured. Experiences among both treated and untreated patients are also discussed vastly but there is limited information on negative perceptions and beliefs among obstetric fistula patients towards their spouses, families, and communities and how these affect social reintegration. This study determined the relationship between self-fulfilling prophecies and social reintegration among obstetric fistula patients in different repair categories. Methods: A cross-sectional mixed-methods survey was done among the obstetric fistula patients (n=398) at St. Joseph Kitovu Hospital in Uganda. Also, 12 key informants participated. A semi-structured questionnaire and an in-depth interview were used to get data from the patients. The interviews covered patients’ expectations and beliefs on reacceptance, interaction, self-satisfaction and comfort with others. The hypothesis: “there was a significant relationship between self-fulfilling prophecies and social reintegration among obstetric fistula patients in different repair categories” was tested by Pearson chi-square at a 95% confidence interval. Results: Accordingly, 51.5%, 14.4% and 9.0% of the 398 participants felt that their spouses, communities, and parents respectively would not reaccept them. Again, 33.6% were not satisfied with their lives and 47.7% felt uncomfortable around others. A major difference was observed in the relationship between their self-perceived stigma, sense of loss, self-worth, achievement, the expectation of reacceptance, perception of others’ attitudes towards them, labeling, moods, self-satisfaction, comfort with others and social reintegration. A relationship with the patients’ repair category was noted across all variables: P-values less than 0.001 at a 95% confidence interval. Conclusion: A relationship was found between the patient’s negative beliefs, perceptions, and social reintegration. Negative beliefs and expectations could be transformed into positive ones through the promotion of personal hygiene and comprehensive counseling.