Obstetric Vesicovaginal Fistula Research Articles

Determinants and predictive model of failure of surgical repair of obstetric vesico-vaginal fistula in the Democratic Republic of the Congo

IntroductionSurgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo.MethodsThis was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer–Lemeshow test.ResultsSurgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73–14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01–27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09–9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36–9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33–21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09–1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%.ConclusionThis study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF.

Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia

BackgroundUrinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia.ObjectivesThe main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia.MethodsA retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome.ResultsIn total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable.ConclusionsNearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.

The Microcirculation of Vaginal Tissue in Women with Obstetric Vesicovaginal Fistula and Short-Term Effects of Surgical Repair on Microvascular Parameters

Objectives: The objective of the study was to better understand the extent of the ischemic trauma and the effects of surgical repair on the vaginal microcirculation in patients with obstetric vesicovaginal fistula (VVF). Design: In this observational study, we evaluated the vaginal microvasculature surrounding VVF using handheld vital microscopy (HVM) before, during, and 2 weeks after surgical VVF repair. Participants: Seventeen women undergoing VVF repair were included in this study. Setting: The study was conducted in the Fistula Care Centre in Lilongwe, Malawi. Methods: We used HVM with incident dark-field imaging to non-invasively visualize the microvasculature of the vaginal tissue surrounding fistulas. The primary outcome was the presence of microvascular flow. Secondary outcomes included angioarchitecture, fistula closure (postoperative dye test), and urinary continence (pad weight test). Results: Microvascular flow was present before, during, and after surgical repair in, respectively, 83.8%, 83.9%, and 93.4% of obtained image sequences. The angioarchitecture was normal in 75.8% of the image sequences before surgery, 69.4% at fistula closure, and 89.1% two weeks after VVF repair. Fourteen (82.4%) patients had a closed fistula after surgical repair. Limitations: The study was limited by the lack of a control group and the relatively small sample size. Conclusion: Although the vaginal microcirculation in women with VVF is compromised, extensive ischemic damage is not observed in the tissue surrounding fistulas. This suggests significant regenerative capacity of the vaginal vasculature in young women, or less extensive ischemic damage than presumed. Following surgical repair, we observed improvement of microcirculatory flow and angioarchitecture, suggesting that surgery is a good option for patients with obstetric VVF.

Epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas in Senegal

To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal. This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure. Forty-five (45) VVFs were identified over a period of 6years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13years with extremes of 13years and 75years; 17 patients (37.8%) were older than 45years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32years) (P=0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF. There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF. Level 4: retrospective study.

Two Decadal Experiences in Managing Combined Obstetric Vesicovaginal and Rectovaginal Fistulas: A Study From Northern Indian Tertiary Hospital.

A retrospective study of 28 patients with obstetric combined vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) treated at our centre throughout the last two decades (2002 to 2022) has been conducted. In 12 patients, a preoperative diverting colostomy was performed. Six patients had single-stage surgery (both VVF and RVF repairin the same operation) of which two cases required transabdominal repair and four required transvaginal repair. All single-stage repairs (n=6) were successful in curing urine and faecal incontinence.In 22 patients, VVF was corrected initially via the transvaginal method with Martius flap interposition, followed by RVF repair three months later. In 2/22 patients, there was a leak after RVF repair; therefore, proximal diverting colostomy was performed, and RVF repair was repeated after six months. All cases had effective VVF and RVF repairs, and both urine and faecal incontinence were completely cured. This study suggests the collaborative engagement of aurologist and a surgical gastroenterologist results in an advantageous outcome for the surgical treatment of these intricate obstetric fistulas.

Profile and Outcome of Obstetric Fistula Surgeries in a Fistula Care Centre in South-East Nigeria

Prolonged obstructed labour is the main cause of obstetric vesico-vaginal fistula, however there is growing perception that a proportion of cases may be arising from surgical complications and errors. This study intends to evaluate this observation. A retrospective study of 378 eligible cases of obstetric VVF repaired over a five-year period. Requisite information was retrieved from hospital case records. Dataentry and analysis was done using SPSS version 20. Means and SD, Chi square test and the level of significance set at p&lt;0.05 were calculated. The mean age was 33.9±10.1 years, mostly multipara, majority following caesarean sections in 62.3% followed by prolonged obstructed labour in 28.6% of patients. The most common type of VVF was Intra-cervical fistula in 55.8% of patients. At the time of hospital discharge following repair, 76.5% were closed and dry, 18.5% had post-repair incontinence and 5.0% had a failed repair within the studied period. Half of our patients (50.3%) were referred from private hospitals, 40.3% had no referral letter and the remaining were referred from government hospitals. The outcomes of surgeries were not influenced by the type of VVF repaired. Chi square test was 0.38 at 95% CI (p&gt;0.05). There is a worrisome proportion of obstetric VVF from caesarean sections. Our success rates in obstetric VVF repair appears satisfactory; more effort be made in strengthening the referral system and impacting correct surgical skills especially in areas of caesarean section.

Evaluation of the Anesthetic Management of Patients with Obstetric Fistula at CHU-Point G

Introduction: Our study aimed to evaluate the anesthetic management of women suffering from obstetric vesico-vaginal fistulas at the Point G University Hospital. Patients and Methods: A descriptive retrospective study from 02 January 2018 to 31 December 2018 in the anesthesia-intensive care unit of the University Hospital Center (CHU) of Point G. Results: During the study period, we collected 48 cases of obstetric fistula out of a total of 237 operated during the period, a frequency of 20.25% of all surgical activities. Housewives were the most represented with 72.91% of cases. The most affected age group was 21-30 years with 37.5% of cases. Anesthesia was performed in 87.5% of cases by a medical assistant. The technique used was spinal anesthesia, so all patients received bipuvacaine for their anesthesia. One case of low blood pressure and one case of bradycardia were intraoperative incidents or a total of 2.08% of cases. Conclusion: Resuscitation anesthesia plays an important role in the successful management of obstetric fistula. Regional anesthesia is the most widely used method.

Risk Factors of Vesicovaginalis Fistule in Obstetric and Gynecologic Division of Dr. Mohammad Hoesin General Hospital in 2018-2020

Background. A vesicovaginal fistula (FVV) is a direct pathological connection between the bladder and vagina resulting in uncontrolled leakage of urine into the vagina from the bladder. Based on the cause, fistulas are divided into two, namely obstetric fistula and gynecological fistula. The risk factors that influence the occurrence of FFV consist of obstetric risk factors (age, parity, delivery method, duration of delivery, birth weight) and gynecological risk factors (history of gynecological surgery, history of pelvic radiotherapy, history of gynecologic malignancy). The purpose of this study was to determine the relationship between risk factors and the incidence of vesicovaginal fistula.&#x0D; Methods. This research is an observational-analytic study with a cross-sectional method. The number of samples obtained was 74 patients who met the inclusion criteria using secondary data from medical records. Analysis of the data used is the chi-square test.&#x0D; Results. There were 37 people who experienced vesicovaginal fistula. Where there were 9 patients with obstetric vesicovaginal fistula (24.3%) and 28 people (75.7%). From the Chi-Square test analysis, there was a significant relationship between delivery method (p=0.029), birth weight (p=0.029), history of gynecological surgery (p=0.038), history of pelvic radiotherapy (p=0.016), history of gynecological malignancy (p=0.016). =0.010). Meanwhile, there was no significant relationship between age (p=0,347), parity (p=1,000), and duration of labor (p=0,082).&#x0D; Conclusion. There was a significant relationship between the delivery method, birth weight, history of gynecological surgery, history of pelvic radiotherapy, history of gynecological malignancy. There was no significant relationship between age, parity, and duration of vaginal delivery.

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

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.

Risk Factors for Urinary Incontinence after Obstetric Vesicovaginal Fistula Closure in Guinea

Introduction: Urinary incontinence after closure of vesicovaginal fistula is any involuntary loss of urine that a patient complains of. We aim to study the risk factors for urinary incontinence after closure of obstetric vesicovaginal fistula in Guinea in order to develop preventive measures to reduce its incidence. Materials and Methods: This was a retrospective, multiple center cohort of women operated on for obstetric vesicovaginal fistula during a 10-year period. Results: In 1770 vesicovaginal fistulas operated, 1347 were closed. 180 women (13.36%) developed urinary incontinence. After multivariate analysis, the risk factors of urinary incontinence after closure of vesicovaginal fistula were: the patient’s age, the anatomical type III, iterative surgical intervention, the brevity of the urethra and decrease in bladder capacity. Conclusion: Urinary incontinence after closure of vesicovaginal fistula is a frequent problem in Guinea, the prevention of which should be integrated into the management of fistulas.

Vesicovaginal fistulas: diagnosis and surgical management

Vesicovaginal fistulas (VVF) represent a detrimental condition causing psychological, physical and social strain on patients. In developed countries they are predominantly the result of pelvic surgery or radiation therapy, whilst obstetric VVF are common in developing countries due to prolonged and complicated births. The majority of VVF require surgical therapy, thus a comprehensive diagnostic workup is needed. Depending on diagnostic characteristics fistula repair can be performed by a transvaginal, transabdominal or minimally invasive approach. Timing of surgery, appropriate interposition of vascularized grafts, optimized postoperative management and surgical expertise are determining factors for successful treatment. This review describes the diagnostic workup and therapeutic management of VVF including various surgical techniques.

Physical etiology of sexual dysfunction in obstetric fistula patients: A prospective study.

To understand how the physical etiology of sexual dysfunction among women with obstetric fistulas can inform repair. A prospective cohort study included women aged 18years or over presenting at the Fistula Care Center, Bwaila Maternity Hospital, Lilongwe, Malawi, with obstetric vesicovaginal fistula before and after repair. The study took place between January 1, 2018, and December 31, 2018, and involved physical examinations and interviews. The primary outcome was sexual function. 115 were interviewed before and after repair. 44 (40.0%) preoperatively and 14 (12.2%) postoperatively reported sexual dysfunction. 94 women (81.7%) had little or no interest in sexual activity before repair. 55 women (47.8%) had little or no interest in sexual activity after repair. Before surgery, 69 women (60.0%) were not sexually active in the 30days before coming to the Fistula Care Centre. After surgery, 32 women (27.8%) were not sexually active in the 30days before returning to the Fistula Care Centre. Of those who were not sexually active in the 30days before coming to the Fistula Care Centre (n=69), the majority cited their health as a reason before repair (n=45, 65.2%), while the most commonly cited reason after repair was an absent partner (n=23, 35%). Given the significant percentage of women with obstetric fistula reporting sexual dysfunction after repair, a more holistic perspective of health outcomes should be considered. Further investment should be made in screening tools and surgical techniques targeting sexual dysfunction.

Extended bladder catheterization for women with positive dye tests after obstetric vesicovaginal fistula repair surgery.

To determine the success rate and factors that result in a negative dye test after extended bladder catheterization after surgery for obstetric fistula. A retrospective cohort study was carried out on women who underwent obstetric fistula repair in Malawi and had ≥14days of bladder catherization. Variables such as age, class of fistula, previous repairs, menopausal status, and HIV status were examined for association with successful healing at the end of the catheterization period. Fifty-two patients had a positive dye test after the intended period of catheterization and the catheterization period was extended by 7days. Of these patients, 29 (55.7%) had a subsequent negative dye test. Older women (mean age 28.4years) who developed a fistula were more likely to have a negative dye test after extended catheterization, compared to their younger counterparts (mean age 20years) (P=0.0018). Other variables were not found to be significantly different between the two groups. More than half of the patients with a positive dye test had complete closure of the fistula defect after an extension of bladder decompression. It is reasonable to consider an extension of bladder catheterization for 7days after an initial positive dye test.

Obstetric Vesico-vaginal Fistulae: A Documentary Review of Women Managed in Mendefera Zonal Referral and National Fistula Hospital, Eritrea

Background: obstetric fistula is a devastating childbirth injury as a result of obstructed labor. It leads to chronic urinary incontinence and, in most cases, significant physical and emotional suffering. Its prevalence is high in Sab-Sahara African and South Asian countries. The objective of this study is to determine the incidence and describe the characteristics of women with obstetric Vesico-vaginal fistula. Methods: A retrospective cross-sectional study was conducted in all obstetric vesico-vaginal fistula patients. Patient identification performed through review of prerecorded logbook and patient card describing each patient admitted to fistula ward over a period of five years from January 1st 2014 to December 31, 2018. Medical records were reviewed to obtain data on socio-demographic and obstetric characteristics, clinical details, and treatment. Statistical analysis was performed using STATA-9. Results: There were 146 women with Vesico-vaginal fistula (VVF) admitted to the fistula hospital over the study period; of which 144 of them were obstetric fistula. During the study period the total number of health facility deliveries in Eritrea was 217,119 giving an estimated rate of obstetric VVF of 0.7/1000 facility deliveries. The median age, parity, and number of live births was 30, 3, and 2, respectively. One quarter (n=37) of the cases being in the age group of 20years or younger. The highest incidence of VVF (38%) was observed in Primiparous. 75% gave birth in a health facility, 54% of deliveries were by caesarean section, and 80% of babies were stillborn. 77% of repairs were successful. Conclusion: The incidence of fistula in Eritrea is relatively low as compared to other sub-Saharan African countries. In this study, age at fistula development was older than usually found, which might be due to poor access to emergency obstetric care (EmOC) that contributed more to this problem.

Healthcare Access as a Risk-Marker for Obstetric Vesicovaginal Fistula in Malawi.

Objectives:To determine the association between access to health care among pregnant women in Malawi and occurrence of obstetric vesicovaginal fistula (VVF).Methods:This was a case-control study using data obtained from patients’ records documented by the ‘Fistula Care Center-Bwaila Hospital’ in Malawi. Socio-demographic characteristics of women with VVF (study arm, n=1046) and perineal tear (control arm, n=37) were examined. A composite variable called “Malawi Healthcare Access Index” (MHAI) was created through summation of scores related to three factors of access to care: (1) walking distance to closest health center; (2) presence of trained provider at delivery; and (3) receipt of antenatal care. Binomial logistic regression models were built to determine the association between the MHAI and presence of VVF.Results:Obstetric VVF was more common in women from rural areas, mothers delivering at extremes of age, those with less education, and patients with long labor (>12 hours). In adjusted models, women with “insufficient” health access based on the MHAI were at greater risk (OR = 2.64, 95%CI = 1.07 – 6.03) of obstetric VVF than women with “sufficient” score on the MHAI.Conclusion and Global Health Implications:Inadequate access to essential obstetric care increases the risk of VVF.

Henry van Roonhuyse and the first repair of a vesico-vaginal fistula (~1676).

Obstetric vesico-vaginal fistula is a traumatic complication of prolonged obstructed labor in which pressure necrosis from the impacted fetal head destroys portions of the vesico-vaginal septum, resulting in continuous and uncontrollable urinary incontinence. Ancient evidence suggests that fistula cases have probably been occurring since the development of rotational delivery mechanics in anatomically modern humans hundreds of thousands of years ago. It is likely that attempts to repair such injuries also have a long history. The early history of vesico-vaginal fistula surgery was investigated to determine the earliest credible report of successful cure of this condition. Historical review of vesico-vaginal fistula surgery was undertaken, focusing on the work of Henry Van Roonhuyse, a seventeenth century Dutch surgeon living in Amsterdam. Van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) was reviewed in detail and is described in this article. His technique for vesico-vaginal fistula repair included six essential steps that are still recognizable today: (1) use of the lithotomy position; (2) exposure of the fistula with a speculum; (3) sharp paring of the fistula edge prior to attempted closure; (4) careful approximation of the denuded edges of the fistula; (5) dressing of the wound with absorbent vaginal packing; (6) immobilization of the patient in bed until the repair has healed. Henry Van Roonhuyse is the most credible candidate presently known for having successfully repaired a vesico-vaginal fistula in the pre-modern era.

An evaluation of the impact of post-hysterectomy vesicovaginal fistula repair on the mental health of patients in a developed country.

Obstetric vesicovaginal fistulae (VVFs) occur frequently as a result of childbirth in developing countries, but occurrence of VVFs in developed countries is rare and is generally observed after hysterectomy. Moreover, there are no reports regarding the effect of post-hysterectomy VVF repair on the patients' mental health in developed countries. Our study aimed to confirm the effect of post-hysterectomy VVF repair on Japanese iatrogenic VVF patients' mental health. A retrospective chart review was performed for 31 patients who underwent post-hysterectomy VVF repair. Each patient's urinary incontinence and mental state were evaluated using two questionnaires, the International Consultation on Incontinence Questionnaire-Short Form and the Hospital Anxiety and Depression Scale questionnaires, respectively, at baseline and at 3 or 6months post-surgery. The Wilcoxon signed-rank test was used to compare the pre- and post-repair scores of each questionnaire, while McNemar's test was used to compare the pre- and post-repair proportions of patients with anxiety and depression. Of the 31 patients, 13 (41.9%) underwent hysterectomy because of malignancies. All questionnaire scores showed significant improvement after VVF repair. The prevalence of clinical anxiety and depression decreased from 51.6% to 16.1% (P < 0.01) and from 51.6% to 12.9% (P < 0.01), respectively, after VVF repair, and urine leakage through fistulae was not observed in any patient after VVF repair. Our results suggest that iatrogenic VVF can have severe impacts on patients' mental health, but VVF repair can significantly improve it.

Model predicting failure in surgical repair of obstetric vesicovaginal fistula

IntroductionIl y a plus de 2 millions de cas de fistule génitale en Afrique subsaharienne et en Asie. Elles surviennent dans les zones où l'accès aux soins à l'accouchement est limité ou de qualité médiocre et où peu d'hôpitaux offrent les interventions chirurgicales correctives nécessaires. L'objectif de cette étude est de développer un score prédictif permettant d'identifier les facteurs influant sur l'échec de la réparation chirurgicale de la fistule obstétricale vésico-vaginale (ERCF) dans la partie Sud-Est de la province du Haut-Katanga.MéthodesIl s'agit d'une étude transversale analytique menée sur 384 femmes porteuses d'une fistule obstétricale vésico-vaginale ayant bénéficié d'une prise en charge chirurgicale. Nous avons procédé par une analyse univariée puis multivariée. La discrimination du score était évaluée à l'aide de la courbe Receiving Operating Characteristics (ROC) et du C-index et la calibration du score selon le test d'Hosmer-Lemeshow.RésultatsLa réparation chirurgicale de la fistule obstétricale vésico-vaginale s'était soldée par un échec dans 17,19% des cas (66/384). Après modélisation logistique, quatre critères ressortent comme facteurs prédictifs d'ERCF: la présence d'une fibrose cicatricielle (ORa=15,22; IC95%: 7,34-31,58), la présence de 2 fistules ou plus (ORa=7,41; IC95%: 3,05-17,97), l'abord trans-vésical comme voie d'abord (ORa=4,26; IC95%: 1,92-9,44) et l'atteinte urétrale (ORa=3,93; IC95%: 1,99-7,77). L'aire sous la courbe ROC du score est de 0,8759 avec une sensibilité de 57,58%, une spécificité de 91,82% et une valeur prédictive positive de 91,25%.

Co morbidities associated with vesico vaginal fistula in patients managed in Maryam Abacha Fistula Hospital Sokoto, Northwestern Nigeria

Background: Prolong obstructed labor is a preventable obstetric complication in the developing countries with devastating consequences and comorbidities. This study aimed to determine the frequencies of the common comorbidities in patients managed for obstetrics fistula at Maryam Abacha Women and Children Hospital, Sokoto, and also to identify the association of age and parity on the occurrence of some of the comorbidities observed. Materials and Methods: This was a cross-sectional study involving 179 patients with obstetric vesicovaginal fistula seen at Maryam Abacha women and Children VVF center, Sokoto, from January to December 2017. A proforma was used to assess the sociodemograhic features and also to record comorbidities during preoperative evaluation. Results: Foot drop was the commonest comorbidity seen in 106 (59.2%), followed by depression in 104 (58.1%). There was statistically significant association between age, parity, and foot drop P = 0.025. Depression was found to be higher in the primipara P = Conclusion: Significant comorbid conditions accompany obstetrics trauma and vesicovaginal fistula. Foot drop had statistically significant association with age. Depression was common in all age groups. There was significant association between depression and parity. Urinary dermatitis occurred more frequently in the older age group and multiparae.

Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study.

We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously. Prospective cohort study. Fistula Care Centre in Lilongwe, Malawi. Women who had undergone VVF repair in Lilongwe, Malawi at least 12months prior to enrolment. Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire. Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation. Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR=2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR=2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence. While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group. Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.