Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019

A systematic review and meta-analysis of urinary incontinence following successful obstetric fistula repair: findings from five countries in sub-Saharan Africa

BACKGROUND

Obstetric vesico-vaginal fistula is a known complication that can occur following damage to the bladder wall during prolonged obstructed labor and operative delivery. Urinary incontinence following the repair of obstetric fistula remains a significant health problem and can greatly damage a women's ability to function confidently. There are approximately two million women suffering from urinary incontinence following obstetric fistula repair, most of whom are primarily in Africa.

OBJECTIVE

We aimed to systematically review and conduct meta-analysis on the magnitude of urinary incontinence among women following successful obstetric fistula repair in sub-Saharan African countries.

METHODS

We thoroughly searched online database including Medline, Scopus, Science Direct, Excerpta Medica Database, African Journals Online and Google Scholar for eligible articles from their inception to November 10, 2024. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 checklist. To generate pooled prevalence of urinary incontinence, we used random-effects model. The presence of publication bias was determined using a funnel plot and Egger's regression test.

RESULTS

Out of 1044 articles found following our initial search and after titles and abstracts review, we considered 277 full text articles for inclusion. Lastly, a total of 12 articles from five sub-Saharan African countries comprising 6,104 participants met the inclusion criteria for quantitative meta-analysis. The pooled prevalence of urinary incontinence following obstetric fistula repair was 16.32% (95%CI: 11.80, 20.84; I2 = 96.5%, P < 0.001).

CONCLUSION AND IMPLICATIONS

Overall, our findings show post-fistula repair incontinence remains an important clinical problem. Therefore, we believe that policy planners and researchers of sub-Saharan African nations may use the findings of the current study for evidence based care planning and patient counseling strategy.

REGISTRATION

Registered in PROSPERO under protocol number CRD42023416541.

FIGO good practice recommendations to standardize the assessment of outcomes following vesicovaginal fistula surgery

Obstetric fistula is a debilitating childbirth injury causing immense suffering for women and girls with the condition. The majority of fistulas can be successfully treated with a surgical repair, performed by a competent surgeon who has undergone specialist training and who works with a holistic fistula care team. As well as surgical repair, a critical component of fistula treatment is meticulous postoperative assessment to accurately determine surgical outcomes so that further treatment and support can be provided as required, and the risk substantially reduced of any patient being discharged with associated ongoing problems, such as urinary retention or residual/ongoing incontinence. Based on the opinions of experts in the field, these good practice recommendations provide a practical and standardized protocol for the correct assessment of surgical outcomes following vesicovaginal fistula surgery and appropriate subsequent management.

Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia

BACKGROUND

Urinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia.

OBJECTIVES

The main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia.

METHODS

A retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome.

RESULTS

In total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable.

CONCLUSIONS

Nearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.