Obstetric fistula: the use of urethral plugs for the management of persistent urinary incontinence following successful repair

Brook, Gill; Tessema, Azeb Befekadu

doi:10.1007/s00192-012-1887-8

Cited by 18 publications

(7 citation statements)

References 9 publications

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“…The scientific community is not in consensus agreement on the definition of a successful repair. While some researchers believe success should be defined as closure of the fistula [24][25][26], others argue that dryness or continence after repair should be called success [27]. For this study, we defined success as a continent closure because the expectation of a woman with fistula is to get dry.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country

Sambo¹,

Missikpode²

2016

Trop Med Surg

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Introduction: Obstetric fistula is a serious injury resulting from obstructed labor causing significant maternal morbidity in women in developing countries. In order to maximize probability of successful surgical repair, it is important to identify women at-risk for poor surgical outcomes so that they can be given appropriate care. The goal of this study is to explore additional factors associated with fistula repair outcomes, as well as determine whether statistical modeling can be used to create a clinical decision-making tool for predicting a successful repair. Methods: Medical records for 82 patients surgically treated for obstetric fistula in Benin were retrospectively reviewed to collect demographic and clinical information related to their condition and procedure. Individuals were grouped into 3 main outcomes: successful closure with continence, successful closure with residual incontinence, and failed repair. A backwards stepwise selection methodology and logistic regression were used to select factors and examine their associations with the surgical outcomes. Structural equation modelling was used to develop a prediction tool for successful repair. Results: Location of fistula (vesicovaginal, vesicouterine, ureteroalvaginal, ureterouterine, and rectovaginal) (OR=7.6 (2.39, 24.36)), being married (OR=3.45 (1.09, 10.90)), parity of 1 to 3 (OR=2.99 (0.94, 9.49)), duration of fistula less than 10 years (OR=2.07 (0.88, 8.25)), and no previous repair attempt (OR=2.40 (0.79, 7.25)) were found to favor a successful closure with continence. We developed a prediction tool to sort women with obstetric fistula into 5 different categories based on probability of success. Our model suggests that marital status affects successful repair through a mediating factor not yet identified. Conclusion: This study classified fistulous women into clinically relevant categories based on the probability of a successful repair. The results from the present study may inspire further research on identifying fistulas with poor prospect of success, which might benefit from more specialized care.

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Section: Study Population and Data Collectionmentioning

confidence: 99%

Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country

Sambo¹,

Missikpode²

2016

Trop Med Surg

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“…Women with an unrepaired fistula may be able to have another repair attempt or be considered for a urinary diversion. For women with residual incontinence after a successful OF repair, continence may be achieved with non‐invasive techniques such as pelvic floor strengthening, bladder training or urethral plugs . Additionally, surgical procedures to alleviate stress urinary incontinence can be considered for these patients .…”

Section: Discussionmentioning

confidence: 99%

Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study

Kopp

Bengtson

Tang

et al. 2017

BJOG

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Objective Determine if a 1-hour pad test at discharge can identify continence status within 120 days of obstetric vesicovaginal fistula (VVF) repair. Design Prospective cohort study. Setting Fistula Care Centre in Lilongwe, Malawi. Population Women with VVF who underwent repair between January 2012–December 2014. Methods Data on demographics, obstetric history, physical exam findings, operative management, post-operative findings, and follow-up evaluations were collected on women with VVF repair. Main outcome measures Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and a receiver operating curve (ROC) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow-up. Results After VVF repair, 346 women had a 1-hour pad test performed at the time of hospital discharge and completed follow-up within 120 days of repair. Of these, 79.8% (n=276) were completely continent, while 20.2% (n=70) had some degree of incontinence. The sensitivity and specificity of a negative 1-hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5-gram threshold demonstrates a high predictive value (PPV=94.0%, 95% CI 90.0, 96.9) in detecting women with continence after repair. Conclusions At the 1.5-gram threshold, a negative pad test at discharge identifies 94% of women who will remain continent after VVF repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow-up after repair is difficult. Tweetable abstract A negative pad test after repair is associated with continued continence at follow-up.

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“…Pelvic floor muscle training (PFMT) is recommended as a first line intervention in the management of women with urinary incontinence . Arguably, it might be less effective with women following vesico‐vaginal fistula because of severe damage to the continence mechanism suffered as a result of their obstructed labor . However, Dietz et al, in a study of 95 women in Addis Ababa before or shortly after vesico‐vaginal fistula repair, found that PFM anatomy and function was no more likely to be abnormal than in a general urogynaecological population.…”

Section: Persistent Urinary Dysfunctionmentioning

confidence: 99%

Obstetric fistula: The role of physiotherapy: A report from the Physiotherapy Committee of the International Continence Society

Brook¹

2018

Neurourology and Urodynamics

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Aims: To discuss the role of physiotherapy in the management of women who have suffered an obstetric fistula, referring to research findings when appropriate and available, and the experiences of clinical specialists in the field. Methods: The experiences of physiotherapists who have worked in countries where obstetric fistula is prevalent, and the limited literature available, were considered in producing this consensus document on behalf of the ICS Physiotherapy Committee. Results: The role of physiotherapy both pre-and post-fistula repair was identified, and is multi-faceted. Women may have general rehabilitation needs based on the obstructed labor itself and subsequent care. All affected women may benefit from pelvic floor muscle assessment, education and exercises to optimize the outcome of their surgery; further pelvic floor physiotherapy may be indicated for those who experience persistent genitourinary dysfunction following closure of the fistula. Conclusions: Further robust research is required to confirm the effectiveness of physiotherapy in the management of women who have suffered an obstetric fistula and the optimum development of such services. Based on the available literature and the experience of physiotherapists in the field, there was consensus within the ICS Physiotherapy Committee that patient outcomes can be improved if physiotherapy is provided as part of the multidisciplinary team. Physiotherapy should not be overlooked when fistula services are being developed. K E Y W O R D S physiotherapy, rectovaginal fistula, vesicovaginal fistula

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Obstetric fistula: the use of urethral plugs for the management of persistent urinary incontinence following successful repair

Cited by 18 publications

References 9 publications

Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country

Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country

Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study

Obstetric fistula: The role of physiotherapy: A report from the Physiotherapy Committee of the International Continence Society

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