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Nembunzu D, Mayemba N, Sidibé S, Grovogui FM, Aussak BTT, Banze Kyongolwa DF, Camara BS, Tripathi V, Delamou A. Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019. Front Glob Womens Health 2022; 3:896991. [PMID: 35814834 PMCID: PMC9263387 DOI: 10.3389/fgwh.2022.896991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC). Material and Methods This was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence. Results Overall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21). Conclusion Prior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.
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Affiliation(s)
- Dolores Nembunzu
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Naomie Mayemba
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Sidikiba Sidibé
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- *Correspondence: Sidikiba Sidibé
| | - Fassou Mathias Grovogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | - Bienvenu Salim Camara
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
| | | | - Alexandre Delamou
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
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Mafu MM, Kyongolwa DFB, Aussak BTT, Kolié D, Camara BS, Nembunzu D, Christine AN, Paluku J, Tripathi V, Delamou A. Factors associated with surgical repair success of female genital fistula in the Democratic Republic of Congo: Experiences of the Fistula Care Plus Project, 2017-2019. Trop Med Int Health 2022; 27:831-839. [PMID: 35749231 PMCID: PMC9541372 DOI: 10.1111/tmi.13794] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective We sought to document outcomes and factors associated with surgical success in hospitals supported by the Fistula Care Plus Project in the Democratic Republic of Congo (DRC), 2017–2019. Methods This was a retrospective cohort study analysing routine repair data on women with Female Genital Fistula. Univariate and multivariate analyses were conducted to determine factors associated with successful fistula repair. Results A total of 895 women were included in this study, with a mean age of 34 years (±13 years). The majority were married or in union (57.4%) and living in rural areas (82.0%), while nearly half were farmers (45.9%). The average duration living with fistula was 8 years (±7). Vesicovaginal (70.5%) and complex (59.8%) fistulas were the most common fistula types. Caesarean section (34.7%), obstructed labour (27.0%) and prolonged labour (23.0%) were the main aetiologies, with the causal deliveries resulting in stillbirth in 88% of cases. The vaginal route (74.9%) was the primary route for surgical repair. The median duration of bladder catheterization after surgery was 14 days (interquartile range [IQR] 7–21). Multivariate analysis revealed that Waaldijk type I fistula (adjusted odds ratio [aOR]:2.71, 95% confidence interval [CI]:1.36–5.40), no previous surgery (aOR:2.63, 95% CI:1.43–3.19), repair at Panzi Hospital (aOR: 2.71, 95% CI:1.36–5.40), and bladder catheterization for less than 10 days (aOR:13.94, 95% CI: 4.91–39.55) or 11–14 days (aOR: 6.07, 95% CI: 2.21–15.31) were associated with better repair outcomes. Conclusion The Fistula Care Plus Project in the DRC recorded good fistula repair outcomes. However, further efforts are needed to promote adequate management of fistula cases.
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Affiliation(s)
| | | | | | - Delphin Kolié
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Africa Center of Excellence, University Gamal Abdel Nasser, Conakry, Guinea
| | - Dolores Nembunzu
- Hôpital Saint Joseph, Kinshasa, République Démocratique du Congo
| | - Amisi Notia Christine
- Hopital Général de Référence de Panzi, Bukavu, République Démocratique du Congo.,Université Evangélique en Afrique, Bukavu, République Démocratique du, Congo Hôpital
| | - Justin Paluku
- Hôpital Heal Africa, Goma, République Démocratique du Congo.,Department of Obstetrics and Gynecology, Université de Goma, Goma, République Démocratique du Congo
| | | | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Africa Center of Excellence, University Gamal Abdel Nasser, Conakry, Guinea
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Mpunga Mafu M, Banze DF, Nembunzu D, Maroyi R, Paluku J, Kinja R, Kitambala E, Tena-Tena Aussak B, Bulu Bobina R, Amisi N, Mukuliboy A, Diop A, Tripathi V, Romanzi L, Delamou A. Frequency and management of non-obstetric fistula in the Democratic Republic of Congo: experience from the Fistula Care Plus project. Trop Med Int Health 2020; 25:687-694. [PMID: 32223055 PMCID: PMC7317201 DOI: 10.1111/tmi.13394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To describe the frequency, causes and post‐repair outcomes of NOF in hospitals supported by the Fistula Care Plus (FC+) project in the Democratic Republic of Congo. Methods Retrospective cohort study from 1 January 2015 to 31 December 2017 in three FC + supported fistula repair sites. Results Of 1984 women treated for female genital fistula between 2015 and 2017 in the three FC + supported hospitals, 384 (19%) were considered to be non‐obstetric fistula (NOF) cases. 49.3% were married/in a relationship at the time of treatment vs. 69% before the fistula, P < 0.001. Type III (n = 247; 64.3%) and type I (n = 121; 31.5%) fistulas according to Kees/Waaldijk classification were the most common. The main causes of NOF were medical procedure (n = 305; 79.4%); of these, caesarean section (n = 234; 76.7%) and hysterectomy (n = 54; 17.7%) were the most common. At hospital discharge, the fistula was closed and dry in 353 women (95.7%). Conclusion Non‐obstetric fistula, particularly due to iatrogenic causes, was relatively common in the DRC, calling for more prevention that includes improved quality of care in maternal health services.
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Affiliation(s)
| | | | | | - Raha Maroyi
- Hôpital Général de Référence de Panzi, Bukavu, République Démocratique Congo
| | - Justin Paluku
- Hôpital HEAL Africa, Goma, République Démocratique Congo
| | - Rachel Kinja
- Hôpital Général de Référence de Panzi, Bukavu, République Démocratique Congo
| | | | | | | | - Notia Amisi
- Hôpital Général de Référence de Panzi, Bukavu, République Démocratique Congo
| | - Ange Mukuliboy
- Hôpital Saint Joseph, Kinshasa, République Démocratique Congo
| | | | | | | | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
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Delamou A, Mpunga M, Banze F, Nembunzu D, Raha K, Paluku J, Kinja R, Kitambala E, Aussak BTT, Bobina RB, Notia A, Mukuliboy A, Diop A, Tripathi V, Romanzi L. Frequency and management of non-obstetric fistula in the Democratic Republic of Congo: experience from Fistula Care Plus project. Nepal J Obstet Gynaecol 2018. [DOI: 10.3126/njog.v13i2.21883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims: To describe the frequency and management of non-obstetric fistula (NOF) in Democratic Republic of Congo (DRC).
Methods: A retrospective cohort study reviewed patients’ medical records in three fistula repair sites supported by the USAID-funded Fistula Care Plus (FC+) Project, covering 1 January 2015 to 31 December 2017. Study variables included demographic characteristics, fistula etiology as reported by surgeon, fistula type (Waaldijk classification), and treatment outcomes.
Results: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three sites, 384 (19%) were considered to be NOF cases. 91% of these women resided in rural areas. 49.3% were married/in relationship at time of treatment compared to 69% before the fistula (p<0.001). Most (n=316; 82.3%) had no previous repair attempts and 96.2% had an intact urethra. Type III (n=247; 64.3%) and type I (n=121; 31.5%) fistulas (Waaldijk classification) were most common. The main causes of NOF were medical procedure (n=305; 79.4%), congenital origin (41; 10.7%) or sexual assault (28; 7.3%). Caesarean section (n=234; 76.7%) and hysterectomy (n=54; 17.7%) were the most common causative procedures. 369 women with NOF received surgical repair (96%), mainly through routine services (n=317; 85.9%). At discharge, 353 women were closed and dry (95.7%) and 11 were closed with residual incontinence (3.0%).
Conclusions: NOF, particularly due to iatrogenic causes, was relatively common in DRC. Surgical repair at FC+-supported sites led to good clinical outcomes. However, to achieve a fistula-free generation in DRC, prevention of iatrogenic fistula is needed, requiring improved quality of maternal care.
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Nembunzu D, Mpunga M, Banze F, Tena BT, Tripathi V. Risk factors and management of obstetric fistula associated with bladder calculus at Saint Joseph Hospital, Kinshasa - DR Congo. Nepal J Obstet Gynaecol 2018. [DOI: 10.3126/njog.v13i2.21880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims: Obstetric fistula can be complicated by bladder calculus. The mechanism of lithogenesis is caused by some predisposing factors. The article aims to describe risk factors predisposing to bladder calculus formation and repair outcome.
Methods: This was a comprehensive retrospective review from medical records of fistula obstetric repairs associated with bladder calculus at Saint Joseph Hospital in Kinshasa, DR Congo, from January 2007 to December 2017.
Results: Among 1416 women who had had obstetric fistula, 30 (2.12%) had bladder calculus. The average age of women was 38 years old and ranged between 22 and 82 years old. The average duration of fistula was 8 years and ranged from 5 months to 31 years. All fistulas were iatrogenic and 86.67% (n = 26) occurred after caesarean section. Size of calculus varied between 1 cm and 15 cm. Risk factors identified were: urinary tract infection 80% (n = 24), foreign bodies 13.33% (n = 4), malnutrition and dehydration in 33.33%. In majority of cases (90%), the removal of the calculus and repair of fistula were performed at the same time by transvesical way. 70.37% of the patients had successful repairs.
Conclusions: Iatrogenic fistula after caesarean section, urinary tract infection and foreign bodies are related to the formation of bladder calculi. Fistula repair and extraction of bladder calculus performed at the same time gives good results. Access to Obstetric Emergency Care, qualified personnel and available infrastructure and equipment are important for the prevention of the occurrence of bladder calculus.
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