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

Abstract

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.

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

“…1,2 We agree wholeheartedly that risk needs to be communicated to the patient and her partner whether she is undergoing surgery for AIP or considering pregnancy with underlying complex maternal heart disease. A recent UK ruling from the Supreme Court has brought this to the forefront and clearly demonstrates that we can no longer practise medicine in a paternalistic fashion.…”

“…A recent UK ruling from the Supreme Court has brought this to the forefront and clearly demonstrates that we can no longer practise medicine in a paternalistic fashion. 1 All the authors of our paper have had individual experience counselling women undergoing very high-risk pregnancies, and we feel that women must to be provided with clear, accurate information that includes all aspects, even when that might cause anxiety. Nothing less than this is acceptable.…”

“…We must therefore make every effort to support staff who are 'caught up' in such circumstances so that they themselves do not become victims. Re: Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study Sir, We read with interest the article 'Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study', 1 and it generated good debate in our hospital Journal Club. Ensuring appropriate follow-up after fistula repair is clearly challenging in a low-resource setting, and the authors' efforts to utilise a simple, low-cost tool to predict outcome and enable targeting of resources should be commended.…”

“…Authors' reply Sir, We thank the participants of the Bedford Hospital Journal Club for their interest in our paper 1 Re: Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?…”

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

“…We thank the participants of the Bedford Hospital Journal Club for their interest in our paper and the expressed concerns …”