Determinants of postoperative outcomes of female genital fistula repair surgery.
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 (RRs) and 95% confidence intervals (CIs).


RESULTS
Women who returned for follow-up 3-month postsurgery were included in predictors of closure analyses (n=1,274). Small bladder size (adjusted RR 1.57, 95% CI 1.39-1.79), prior repair (adjusted RR 1.40, 95% CI 1.11-1.76), severe vaginal scarring (adjusted RR 1.56, 95% CI 1.20-2.04), partial urethral involvement (adjusted RR 1.36, 95% CI 1.11-1.66), and complete urethral destruction or circumferential defect (adjusted RR 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=1,041). Prior repair (adjusted RR 1.37, 95% CI 1.13-1.65), severe vaginal scarring (adjusted RR 1.35, 95% CI 1.10-1.67), partial urethral involvement (adjusted RR 1.78, 95% CI 1.27-2.48), and complete urethral destruction or circumferential defect (adjusted RR 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.
EngenderHealth and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. mbarone@engenderhealth.org
Mark A
MA
Barone
Vera
V
Frajzyngier
Joseph
J
Ruminjo
Frank
F
Asiimwe
Thierno Hamidou
TH
Barry
Abubakar
A
Bello
Dantani
D
Danladi
Sanda Oumarou
SO
Ganda
Sa'ad
S
Idris
Maman
M
Inoussa
Maura
M
Lynch
Felicity
F
Mussell
Dulal Chandra
DC
Podder
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D016012:Poisson Distribution; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology; D014624:Vaginal Fistula / Q000150:complications / Q000601:surgery*; D055815:Young Adult