Determinants of Postoperative Outcomes of Female Genital Fistula Repair Surgery

Barone, Mark A.; Frajzyngier, Vera; Ruminjo, Joseph K.; Asiimwe, Frank; Barry, Thierno Hamidou; Bello, Abubakar; Danladi, Dantani; Ganda, Sanda Oumarou; Idris, Sa’ad; Inoussa, Maman; Lynch, Maura; Mussell, Felicity; Podder, Dulal Chandra

doi:10.1097/aog.0b013e31826579e8

Cited by 70 publications

(89 citation statements)

References 17 publications

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“…Women with fistulas that involve the urethral closure mechanism are at high risk of post-operative urinary incontinence. (8) To help improve the changes of regaining continence after surgery a pubococcygeal sling or other sling-like techniques (13) are used in all women with a short urethra (approximately ≤2 cm) as a preventative measure. After surgery, women received antibiotics on a case by case basis based on risk factors during surgery or post-operative risk assessment.…”

Section: Methodsmentioning

confidence: 99%

“…However, due to the rural nature of much of Malawi and the fact that the Fistula Care Center draws women from around the East Africa region, women included in this analysis were allowed up to 120 days from time of surgery to return for follow-up. We chose incontinence, rather than fistula closure, as our primary outcome since 20% (8) of women with a successful closure may remain incontinent. (5-7)…”

Section: Methodsmentioning

confidence: 99%

“…(5-7) Surgical success based on anatomical closure varies from 80%-95%. (5) However, up to 20% (8) of women with successful fistula closure continue to suffer from residual urinary incontinence after surgery. Overall, between 5% (9) and nearly 40% of women experience residual incontinence after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery

Bengtson

Kopp

Tang

et al. 2016

Obstetrics &Amp; Gynecology

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Objective To develop a risk score to identify women with vesicovaginal fistula at high risk of residual urinary incontinence after surgical repair. Methods We conducted a prospective cohort study among 401 women undergoing their first vesicovaginal fistula repair at a referral fistula repair center in Lilongwe, Malawi, between September 2011 and December 2014, who returned for follow-up within 120 days of surgery. We used logistic regression to develop a risk score to identify women with high likelihood of residual urinary incontinence, defined as incontinence grade 2-5 within 120 days of vesicovaginal fistula repair, based on preoperative clinical and demographic characteristics (age, number of years with fistula, HIV status, body mass index, previous repair surgery at an outside facility, revised Goh Classification, Goh vesicovaginal fistula size, circumferential fistula, vaginal scaring, bladder size, and urethral length). The sensitivity, specificity, positive and negative predictive values of the risk score at each cut-point were assessed. Results Overall, 11 (3%) women had unsuccessful fistula closure. Of those with successful fistula closure (n=372), 85 (23%) experienced residual incontinence. A risk score cut-point of 20 had sensitivity 82% (95% CI 72%, 89%) and specificity 63% (95% CI 57%, 69%) to potentially identify women with residual incontinence. In our population, the positive predictive value for a risk score cut-point of _20 or higher was 43% (95% CI 36%, 51%) and the negative predictive value was 91% (95% CI 86%, 94%). Forty-eight percent of our study population had a risk score ≥20 and therefore, would have been identified for further intervention. Conclusions A risk score 20 or higher was associated with an increased likelihood of residual incontinence, with satisfactory sensitivity and specificity. If validated in alternative settings, the risk score could be used to refer women with high likelihood of postoperative incontinence to more experienced surgeons.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery

Bengtson

Kopp

Tang

et al. 2016

Obstetrics &Amp; Gynecology

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“…Therefore, smaller fistula size after prior repair may be one explanation of the comparable success rate on second repair. In a prospective cohort study with 1,274 patients with female genital fistulas, Barone et al [22] found fistula size had no relationship with the successful closure of repair. However, the participants in the study consisted of a heterogeneous population of patients with various genital fistulas.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

Zhou

Yang²,

Luo³

et al. 2016

Urol Int

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Introduction: We aimed to report the outcomes of patients undergoing vesicovaginal fistula (VVF) repair to identify prognostic factors. Materials and Methods: Patients who underwent VVF repair between January 2009 and October 2015 were reviewed. Primary outcome was fistula closure at 3 months. Results: A total of 123 patients and 139 procedures of VVF repair were reviewed. The overall success rate was 85.6%. There were no significant differences in age (p = 0.476), etiology (p = 0.900), fistula duration (p = 0.491) and number of repairs (p = 0.509) between success and fail group. Moderate or severe perifistula fibrosis and multiple fistula were associated with failure in repair of fistula (70.8 vs. 93.4%, p < 0.001; 62.5 vs. 88.6%, p = 0.005). No difference was seen in success rate of vaginal and abdominal approaches (86.0 vs. 85.0%, p = 0.800). Logistic regression analysis identified fistula number (p = 0.003) and perifistula fibrosis (p = 0.002) as 2 independent prognostic factors. Medium/large fistulas were 3.2 times more likely to fail in repair than small fistulas (OR 3.2, 95% CI 0.95-10.6, p = 0.061). Conclusions: Fistula number and perifistula fibrosis were 2 independent prognostic factors for fistula repair. Unsuccessful closure was more likely in medium/large VVF.

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“…Further, there is a shortage of reliable data around social, demographic and clinical factors associated with time to recovery from obstetric Fistula surgical repair that will be valuable for managing health care institution through planning, monitoring and evaluation of quality of care as well as use of human and material resources [29][30][31][32][33][34][35].…”

Section: Significance Of the Studymentioning

confidence: 99%

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

Hailu¹

2018

J Preg Child Health

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Background: Ethiopia is one of the high fistula burdened countries in the world with an annual occurrence of 3,500 new and existence of 37,500 untreated obstetric fistula cases. Studies conducted in this area focus on determinants of obstetric fistula before surgical repair and researches addressing the associated factors are limited.Objective: To estimate time to recovery from a surgical repair of obstetric fistula and its associated factors among patients treated at Mekelle Hamlin Fistula Center. Results: The patients were followed for 6657 person days at risk, the median recovery time was 20 days. The overall recovery rate was 2.5 cases per 100 person days. Multivariable Cox proportional hazard model result showed labor duration of two or more days (AHR=0.73, 95% CI=0.53, 0.99) and post-operative bladder catheterization longer than 14 or more days (AHR=0.45, 95% CI=0.32, 0.62) were factors negatively associated with recovery time from obstetric fistula surgery. Methods Conclusion and recommendations:women who experienced labor of two or more days and post-operative bladder drainage for more than two or more weeks took longer time to recover after the repair. Therefore, Decision makers, Health care professionals, Stakeholders and Researchers should give emphasis on activities that reduce delays' in decision making, delays' in giving urgent intervention and delays' in reaching health institutions that contributes in reducing complications of prolonged labor ultimately obstetric fistula.Harmful traditional practices such as early marriage and home delivery are other potential factors for the development of obstetric fistula [8][9][10]. Globally, nine to 84% of obstetric fistula patients gave birth at home and more than 2 million women are currently living with this problem. Additional 50,000 to 100,000 new cases are estimated to occur each year and majority of which are from Africa and Asia [9][10][11][12][13].Incidence rates of obstetric fistula in countries with high maternal mortality is as high as two to three cases per 1000 women [14]. Estimated incidence and prevalence of untreated obstetric fistula in Ethiopia during the year 2010 was 3,500 and 37,500, respectively [9,15]. Introduction BackgroundObstetric fistula is an injury that occurs during prolonged or obstructed labor causing tissue damage to organs inside the pelvis and resulting in incontinence of urine, feces or both. The dead tissues due to prolonged pressure fall away and a hole will be formed between the vagina and bladder called Vesico-vaginal Fistula (VVF) or between the vagina and rectum called Recto Vaginal Fistula (RVF) [1][2][3].Obstetric fistula is the worst child birth related complication that contributes for 2.5% of the Global daily death of mothers associated with child birth related complications [4].The main causes of obstetric fistula in the developed world are radiation therapy and surgery whereas in developing countries, "the three delays" are responsible, the delay in seeking skilled emergency obstetric care, the del...

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Determinants of Postoperative Outcomes of Female Genital Fistula Repair Surgery

Cited by 70 publications

References 17 publications

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

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