title: Retrospective review of predisposing factors and surgical outcomes in obstetric fistula patients at a single teaching hospital in Western Kenya.
abstract: OBJECTIVE
  We examined success rates and complications of obstetric fistula (OF) surgical repairs in association with patient and fistula characteristics, including sociocultural and socioeconomic determinants of health. A better understanding of these associations will help guide surgical management and prevent predisposing factors.
  
  
  METHODS
  We reviewed the medical records of 86 patients who underwent OF repair at Moi Teaching and Referral Hospital in Kenya between 1999 and 2007.
  
  
  RESULTS
  Women with OF presented for repair with a variety of concurrent conditions. Seventy-eight percent had laboured for at least 24 hours; 29% had undergone previous unsuccessful surgery. Of the women who presented at postoperative follow-up, 54% still complained of incontinence. Persistent incontinence was associated with larger, more complicated fistulas and having had previous failed attempts at surgical repair.
  
  
  CONCLUSIONS
  The association of factors such as duration of labour with OF reflects the limited availability of obstetrical care in Western Kenya. There is a significant difference in postoperative success of fistula repair between women with large fistulas or those who had previous failed surgery and other patients. This reflects the importance of primary and secondary prevention.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON.
authors.forename: Erin
authors.initials: E
authors.lastname: McFadden
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
authors.forename: Sarah Jane
authors.initials: SJ
authors.lastname: Taleski
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.
authors.forename: Alan
authors.initials: A
authors.lastname: Bocking
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Spitzer
authors.affiliation: Department of Obstetrics and Gynecology, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Hillary
authors.initials: H
authors.lastname: Mabeya
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004420:Dystocia / Q000503:physiopathology; D005260:Female; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D011247:Pregnancy; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*; D055815:Young Adult