Mortality risk associated with surgical treatment of female genital fistula (original) (raw)
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BMC Pregnancy and Childbirth, 2014
Background: Treatment and care for female genital fistula have become increasingly available over the last decade in countries across Africa and South Asia. Before the International Federation of Gynaecology and Obstetrics (FIGO) and partners published a global fistula training manual in 2011 there was no internationally recognized, standardized training curriculum, including perioperative care. The community of fistula care practitioners and advocates lacks data about the prevalence of various perioperative clinical procedures and practices and their potential programmatic implications are lacking. Methods: Data presented here are from a prospective cohort study conducted between September 2007 and September 2010 at 11 fistula repair facilities supported by Fistula Care in five countries. Clinical procedures and practices used in the routine perioperative management of over 1300 women are described. Results: More than two dozen clinical procedures and practices were tabulated. Some of them were commonly used at all sites (e.g., vaginal route of repair, 95.3% of cases); others were rare (e.g., flaps/grafts, 3.4%) or varied widely depending on site (e.g. for women with urinary fistula, the inter-quartile range for median duration of post-repair bladder catheterization was 14 to 29 days). Conclusions: These findings show a wide range of clinical procedures and practices with different program implications for safety, efficacy, and cost-effectiveness. The variability indicates the need for further research so as to strengthen the evidence base for fistula treatment in developing countries.
Current practices in treatment of female genital fistula: a cross sectional study
BMC Pregnancy and Childbirth, 2010
Background: Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials.
Background. Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000–2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence. Other gynecologic, neurologic and orthopedic morbidity may occur during fistula development. Women with fistula are stigmatized; limit engagement in social, economic, or religious activities; and report high psychiatric morbidity. Improved global surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events, protecting health and quality of life after surgery. This study seeks to identify predictors and characteristics of post-repair fistula breakdown and recurrence (Aim 1) and post-r...
Profiles and experiences of women undergoing genital fistula repair: Findings from five countries
Global Public Health, 2013
This article presents data from 1354 women from five countries who participated in a prospective cohort study conducted between 2007 and 2010. Women undergoing surgery for fistula repair were interviewed at the time of admission, discharge, and at a 3-month follow-up visit. While women's experiences differed across countries, a similar picture emerges across countries: women married young, most were married at the time of admission, had little education, and for many, the fistula occurred after the first pregnancy. Median age at the time of fistula occurrence was 20.0 years (interquartile range 17.3Á26.8). Half of the women attended some antenatal care (ANC); among those who attended ANC, less than 50% recalled being told about signs of pregnancy complications. At follow-up, most women (even those who were not dry) reported improvements in many aspects of social life, however, reported improvements varied by repair outcome. Prevention and treatment programmes need to recognise the supportive role that husbands, partners, and families play as women prepare for safe delivery. Effective treatment and support programmes are needed for women who remain incontinent after surgery.
Determinants of Postoperative Outcomes of Female Genital Fistula Repair Surgery
Obstetrics & Gynecology, 2012
Objective-To determine predictors of fistula repair outcomes 3 months postsurgery. Methods-We conducted a multicountry prospective cohort study between 2007 and 2010. Outcomes, measured 3 months postsurgery, included fistula closure, and residual incontinence in women with a closed fistula. Potential predictors included patient and fistula characteristics, and context of repair. Multivariable generalized estimating equation models were used to generate adjusted risk ratios (ARR) and 95% confidence intervals (CI). Results-Women who returned for follow-up 3 month postsurgery were included in predictors of closure analyses (n=1,274). Small bladder size (ARR 1.57; 95% CI 1.39-1.79), prior repair (ARR 1.40; 95% CI 1.11-1.76), severe scarring (ARR 1.56; 95% CI 1.20-2.04), partial urethral involvement (ARR 1.36; 95% CI 1.11-1.66), and complete urethral destruction/circumferential defect (ARR 1.72; 95% CI 1.33-2.23) predicted failed fistula closure. Women with a closed fistula at 3 month follow-up were included in predictors of residual incontinence analyses (n=1041). Prior repair (ARR 1.37; 95% CI 1.13-1.65), severe scarring (ARR 1.35; 95% CI 1.10-1.67), partial urethral involvement (ARR 1.78; 95% CI 1.27-2.48), and complete urethral destruction or circumferential defect (ARR 2.06; 95% CI 1.51-2.81) were significantly associated with residual incontinence. Conclusions-The prognosis for genital fistula closure is related to preoperative bladder size, previous repair, vaginal scarring, and urethral involvement. It is estimated that up to 2 million women in resource poor countries are living with a urinary or recto-vaginal fistula (1,2), primarily as a result of prolonged obstructed labor.(3)
The Journal of Obstetrics and Gynecology of India, 2019
Objectives To study aetiology and management of complicated genital fistulae and to evaluate the outcome of the treatment. Methods This observational study enrolled patients with complicated genital fistulae from September 2008 to August 2018 at Sant Parmanand Hospital, Delhi. Patients underwent a reparative surgery or ureteric stenting after a detailed preoperative workup. Patients were followed up for the assessment of outcomes. Results A total of 16 patients were recruited: Ten (62.5%) patients had fistulae secondary to gynaecological surgeries (seven laparoscopic and three abdominal hysterectomies) and six (37.5%) patients had obstetric fistulae. At a mean follow-up of 5.8 years among obstetric fistulae and 7.3 years among post-operative fistulae, 100% success rate was maintained with the first attempt of reparative surgery or ureteric stenting. There were no major complications. Two patients had recurrent urinary tract infections, and one patient had transient urinary incontinence for 4 weeks. Conclusion The study demonstrates that complicated genital fistulae occur more commonly secondary to gynaecological surgeries as compared to obstetric complications in a contemporary cohort from a metropolitan city. A 100% success rate of reparative surgery could be achieved with a transperitoneal approach. Good outcome in ureteric fistulae can be achieved with conservative approach, after proper case selection.
2018
Background: A vesico vaginal fistula (VVF) is an abnormal communication between two epithelial surfaces. In VVF, an abnormal communication may develop between the urinary system and the reproductive system of a woman. Prolonged labour is a major cause of fistula in women: however, fistulas may be caused by rape, malignancies and as a traumatic outcome in abdominal surgeries. The cardinal sign of VVF is continuous urine leakage with offensive smell. Often, these patients are stigmatised and depressed. Objective: The main objectives of the study were to establish predictors of fistula healing and to gain understanding of the first-hand experience of women before and after repair of a vaginal fistula. Design: A mixed method study which employed quantitative and qualitative data collection approaches. Consecutive sampling was used to recruit participants for the quantitative component. A standard tool was developed, pilot tested and used to collect demographic and fistula characteristics. Quantitative data was managed using IBM SPSS and analysed using descriptive and inferential statistics. Purposeful sampling was used to select participants' for indepth interviews. In-depth guide used to guide interviews. All interviews were recorded and transcribed per verbatim. Aanalysis was done in thematic themes. Results: A total of 1224 women with a confirmed diagnosis of fistula were recruited over a three year period, in East Africa. In all of the countries, literacy levels were low. Overall, most women had only been educated to primary school level 62.9%, 17.0% had no education. Only 4.8% women had been educated to college level or higher and all were from Kenya. Most women were unemployed varying from 92.1% for DR Congo and 76.1% for Southern Sudan 76.1%, to 13.5% for Rwanda and 13.2% for Uganda. The mean fistula size was 2.15 cm in diameter, with most fistulas measuring 1-2 cm from the external urethral orifice (EUO) or urethral meatus. At the time of joining the study, 22.4% of women had undergone a previous surgery to repair the fistula and lived with urine leakage for up to twelve months. Vaginal stenosis/scarring were very common (72.4%). There were few combined fistulas (VVF/RVF) (3.0%). The mean success rate of surgery was 94.1%.Sixteen women were interviewed for the qualitative component of study. Two main themes representing the women's journeys emerged: from social isolation to social reintegration. Women felt euphoric following fistula repair, believing that a 'miracle' had occurred. However, the 'post-miracle component' demonstrated that the social and psychological impact of fistula leaves scars that are not easily healed, even when fistula repair is successful. Conclusion: Fistula surgery alone is not adequate in restoring women's health. The impact of fistula in women's lives is felt far beyond the surgical period. These findings point to the urgent need for researchers to conduct psychological assessment in the management of women with fistula and design community based programs aimed at social integration and women empowerment.
Good clinical outcomes from a 7‐year holistic programme of fistula repair in Guinea
Tropical Medicine & International Health, 2015
ObjectivesFemale genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country.MethodsThis was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014.ResultsThe majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (8...
The Lancet. Global health, 2017
Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. 481 women eligible for analysis were identified retr...
Nepal Journal of Obstetrics and Gynaecology, 2018
Aims: To describe the frequency and management of non-obstetric fistula (NOF) in Democratic Republic of Congo (DRC). Methods: A retrospective cohort study reviewed patients’ medical records in three fistula repair sites supported by the USAID-funded Fistula Care Plus (FC+) Project, covering 1 January 2015 to 31 December 2017. Study variables included demographic characteristics, fistula etiology as reported by surgeon, fistula type (Waaldijk classification), and treatment outcomes. Results: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three sites, 384 (19%) were considered to be NOF cases. 91% of these women resided in rural areas. 49.3% were married/in relationship at time of treatment compared to 69% before the fistula (p<0.001). Most (n=316; 82.3%) had no previous repair attempts and 96.2% had an intact urethra. Type III (n=247; 64.3%) and type I (n=121; 31.5%) fistulas (Waaldijk classification) were most common. The main causes of NOF were med...