Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula.
OBJECTIVE
To evaluate: (1) the factors associated with the development of obstetric genitourinary fistula, (2) the incidence of urinary and faecal incontinence following closure of the fistula and (3) the urodynamic findings in women with persistent urinary incontinence.


METHODS
An observational clinical study.


METHODS
A specialised fistula unit in a developing country.


METHODS
Women following successful anatomical closure of obstetric genitourinary fistula.


METHODS
Fifty-five women were enrolled from the Fistula Hospital in Ethiopia, following obstetric fistula repair. Their case records were reviewed and details regarding (1) antecedent obstetric factors, (2) the site, size and type of fistula and (3) pre-operative bladder neck mobility and vaginal scarring were recorded. All women were questioned regarding symptoms of faecal and urinary incontinence. Women reporting urinary incontinence following fistula repair underwent urodynamic investigations.


METHODS
Clinical and urodynamic assessment.


RESULTS
The mean age of the women was 23 years (range 16-45 years). The fistula in 38 women (69%) followed the first delivery and in 17 women (31%) following a subsequent delivery. The mean duration of labour was four days (range 1-9 days). Forty-four women (80%) had an isolated vesico-vaginal fistula and 11 (20%) had a combined vesico-vaginal and recto-vaginal fistula. The mean diameter of the fistula was 2.9 cm (0.5-6 cm). Successful repair occurred in all women. Thirty women (55%) reported persistent urinary incontinence and 21 (38%) altered faecal continence at follow up. In the former group, urodynamic investigations identified genuine stress incontinence in 17 women (31%), detrusor instability in two (4%) and mixed incontinence in 11 (20%).


CONCLUSIONS
This study demonstrates the high rate of successful closure of the fistula in a specialised fistula unit, but highlights the problem of persistent urinary incontinence following closure.
Department of Urogynaecology, The Mercy Hospital for Women, Melbourne, Australia.
Christine
C
Murray
Judith T
JT
Goh
Michelle
M
Fynes
Marcus P
MP
Carey
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005002:Ethiopia; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000209:etiology*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology* / Q000601:surgery; D012006:Rectovaginal Fistula / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics; D014719:Vesicovaginal Fistula / Q000150:complications / Q000503:physiopathology / Q000601:surgery*