title: Predictors of Recurrence and Successful Treatment Following Obstetric Fistula Surgery.
abstract: To determine factors contributing to recurrence and successful treatment of obstetric fistula (OF).
  
  
  
  Data were collected from OF patients in Saint Luc Hospital Kisantu (DR of Congo) between 2007 and 2013. Patients underwent surgical treatment and were evaluated after a follow-up period of 3 months. Successful treatment was defined as no or dry pads whereas recurrence was defined as the persisting need for wearing incontinence pads immediately after the surgery or after a period of dryness. Fistula classification was done according to Waaldijk. Univariate and multivariate analyses were performed using logistic regression, corrected for preoperative and intraoperative OF characteristics.
  
  
  
  Median age of 166 OF patients was 29.11 ± 9. 6 years (range 5-61). The majority of OF was type I (57.2%) followed by type III (20.5 %). There were 20.5% who showed vaginal fibrosis during surgical treatment. The most common location of fistula was pericervical (39.8%). The global recurrence rate at 3 months was 28.3%, with type IIBb (100%) as most the common recurring, followed by IIAb (66.67%) and IIAa (41.18%). There were 71.7%, 15.7%, 12%, and 0.6% patients who were considered completely cured, partially cured (downstaged), persistent, and upstaged, respectively. OF patients with fibrosis were 68% less likely (odds ratio 0.32, 95% confidence interval 0.14-0.73; P = .0065) to be dry in comparison to those without fibrosis. Patients with urethral fistula were 73% less likely (odds ratio 0.27, 95% confidence interval 0.11-0.63; P = .0024) to be dry compared to other locations.
  
  
  
  This study showed that fibrosis and urethral location are independent risk factors for fistula recurrence or persistence following surgical fistula repair.
authors: Department of Development and Regeneration, Urology, KU Leuven, Leuven, Belgium; Department of Surgery, Urology Division, University Hospital of Kinshasa, Kinshasa, DR Congo.
authors: Matthieu
authors: M
authors: Loposso
authors: Department of Development and Regeneration, Urology, KU Leuven, Leuven, Belgium; Department of Urology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
authors: Lukman
authors: L
authors: Hakim
authors: Department of Obstetrics and Gynecology, Saint Luc Hospital, Kisantu, DR Congo.
authors: Jean
authors: J
authors: Ndundu
authors: Department of Surgery, Urology Division, University Hospital of Kinshasa, Kinshasa, DR Congo.
authors: Simon
authors: S
authors: Lufuma
authors: Department of Surgery, Urology Division, University Hospital of Kinshasa, Kinshasa, DR Congo.
authors: Augustin
authors: A
authors: Punga
authors: Department of Development and Regeneration, Urology, KU Leuven, Leuven, Belgium. Electronic address: dirk.deridder@uzleuven.be.
authors: Dirk
authors: D
authors: De Ridder
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D003223:Congo; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007743:Labor, Obstetric; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult