Журнал беременности и здоровья детей

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Predictors of Poor Outcome after Obstetric Vesico-Vaginal Fistula Repair at Comprehensive Community Based Rehabilitation and Disability Hospital in Tanzania: A Retrospective Review of Records

Bertha E Komba, Ali Said, James Chapa

Background: Obstetric fistula is a common and serious maternal morbidity in developing countries. Treatment of the condition involves repair of the fistula. This study aims at determining predictors of poor outcome after obstetric Vesico-Vagina Fistula (VVF) repair at Comprehensive Community Based Rehabilitation and Disability Hospital in Tanzania (CCBRT DH).

Methods: Case notes of all women who underwent obstetric VVF repair from 1st January 2015 to 31st December 2016 were reviewed. Patient’s files, fistula card as well as operating book register were used to retrieve the data. Information extracted were age at current fistula occurrence, parity, marital status, site of the fistula, number of prior repair attempts, route of repair, status of vaginal, residual bladder size and urethral involvement. Poor outcome was defined as failure of fistula closure evaluated by dye test; or presence of urinary incontinence at hospital discharge. Bivariate and multivariate analyses were done for predictors of poor outcome using SPSS version 20.0.

Results: Out of 702 women, 119 (17%) women had poor outcome. Forty two (6%) women had failure of fistula closure, whereas 77 (11%) women had urinary incontinence. Predictors of poor outcome were presence of moderate and severe vaginal scarring (Odds Ratio (OR)=1.9; 95% Confidence Interval (CI)= 1.0, 3.5; p=0.04) and (OR=2.5; 95% CI=1.3, 4.6; p<0.01) respectively; involvement of urethra (OR=3.8; 95% CI=2.3, 6.3; p<0.01); small residual bladder size (OR=2.3; 95% CI=1.3, 4.1; p<0.01); juxtaurethral fistula (OR=2.6; 95% CI= 1.2, 5.4; p=0.01) and having two or more previous repair attempt (OR= 8.4; 95% CI= 1.3, 19.8; p<0.01).

Conclusion: Features of severe urethra and bladder injury, presence of vaginal scarring, fistula close to the urethra as well as number of prior repair attempts; have been shown to predict poor outcome after repair. Case selection according to the experience of the surgeon is vital, considering most scarred fistula and those with destruction of continence mechanism predict poor outcome after repair.