title: Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study.
abstract: OBJECTIVE
  Determine whether a 1-hour pad test at discharge can identify continence status within 120 days of obstetric vesicovaginal fistula (VVF) repair.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Fistula Care Centre in Lilongwe, Malawi.
  
  
  METHODS
  Women with VVF who underwent repair between January 2012 and December 2014.
  
  
  METHODS
  Data on demographics, obstetric history, physical exam findings, operative management, postoperative findings, and follow up evaluations were collected on women with VVF repair.
  
  
  METHODS
  Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and a receiver operating curve (ROC) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow up.
  
  
  RESULTS
  After VVF repair, 346 women had a 1-hour pad test performed at the time of hospital discharge and completed follow up within 120 days of repair. Of these, 79.8% (n = 276) were completely continent, whereas 20.2% (n = 70) had some degree of incontinence. The sensitivity and specificity of a negative 1-hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5-g threshold demonstrates a high predictive value (PPV = 94.0%, 95% CI 90.0-96.9) in detecting women with continence after repair.
  
  
  CONCLUSIONS
  At the 1.5-g threshold, a negative pad test at discharge identifies 94% of women who will remain continent after VVF repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow up after repair is difficult.
  
  
  CONCLUSIONS
  A negative pad test after repair is associated with continued continence at follow up.
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Kopp
authors.affiliation: UNC Department of Epidemiology, Chapel Hill, NC, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Bengtson
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Tang
authors.affiliation: Fistula Care Centre, Lilongwe, Malawi.|Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Chipungu
authors.affiliation: Fistula Care Centre, Lilongwe, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Moyo
authors.affiliation: Fistula Care Centre, Lilongwe, Malawi.|Baylor College of Medicine Department of Obstetrics & Gynecology, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wilkinson
mesh_terms: D041342:Absorbent Pads; D000328:Adult; D005260:Female; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D014719:Vesicovaginal Fistula / Q000601:surgery*
keywords: Africa; Malawi; obstetric fistula; pad test; residual incontinence