TY - JOUR
T1 - Predictors of outcomes in patients with repeat surgery for obstetric fistula
T2 - a retrospective review
AU - Maljaars, Lennart P.
AU - Hesham, Helai
AU - Huisman, Hiske
AU - Nundwe, William
AU - Roovers, Jan-Paul W. R.
AU - Pope, Rachel J.
N1 - Funding Information: We would like to thank Freedom from Fistula who supported the patients with provision of medical care. We also thank Dr. Rik van Eekelen for support with the statistical analysis. Publisher Copyright: © 2023, The Author(s).
PY - 2023/7
Y1 - 2023/7
N2 - Introduction and hypothesis: Predictors of surgical outcomes in patients with an obstetric fistula who have been operated before should be identified in order to guide surgical strategy and optimize counseling of the patient. Methods: This retrospective study is aimed at identifying predictors of outcomes for repeat surgery in 346 patients who had been operated on before for an obstetrics fistula at the Fistula Care Center (FCC) in Lilongwe, Malawi. Repeat cases were only undertaken by advanced and expert surgeons. The primary outcome was successful anatomical closure, based on a negative postoperative dye test. The secondary outcomes involved urinary continence, based on a patient-reported questionnaire and an objective 1-h pad weight test. Logistic regression models were used to test the predictors for statistical significance. Results: Successful fistula closure was achieved in 288 (83%) patients and continence was achieved in 185 (64%) patients after the first repeat attempt at the FCC. Lack of urethral involvement (Goh classification: proximity to the urethra) was shown to be a good predictor of the outcomes: fistula closure and subjective and objective continence. Conclusions: Absence of urethral involvement is an independent predictor for successful outcomes in repeat surgery for obstetric fistulas. Even in the hands of an expert surgeon, the risk of another failure in achieving anatomical closure or subjective or objective continence is between 4 and 5 times higher than when the urethra is not involved.
AB - Introduction and hypothesis: Predictors of surgical outcomes in patients with an obstetric fistula who have been operated before should be identified in order to guide surgical strategy and optimize counseling of the patient. Methods: This retrospective study is aimed at identifying predictors of outcomes for repeat surgery in 346 patients who had been operated on before for an obstetrics fistula at the Fistula Care Center (FCC) in Lilongwe, Malawi. Repeat cases were only undertaken by advanced and expert surgeons. The primary outcome was successful anatomical closure, based on a negative postoperative dye test. The secondary outcomes involved urinary continence, based on a patient-reported questionnaire and an objective 1-h pad weight test. Logistic regression models were used to test the predictors for statistical significance. Results: Successful fistula closure was achieved in 288 (83%) patients and continence was achieved in 185 (64%) patients after the first repeat attempt at the FCC. Lack of urethral involvement (Goh classification: proximity to the urethra) was shown to be a good predictor of the outcomes: fistula closure and subjective and objective continence. Conclusions: Absence of urethral involvement is an independent predictor for successful outcomes in repeat surgery for obstetric fistulas. Even in the hands of an expert surgeon, the risk of another failure in achieving anatomical closure or subjective or objective continence is between 4 and 5 times higher than when the urethra is not involved.
KW - Fistula closure
KW - Obstetric fistula
KW - Repeat surgery
KW - Residual incontinence
KW - Surgical outcomes
KW - Vesicovaginal fistula
UR - http://www.scopus.com/inward/record.url?scp=85145699495&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00192-022-05421-0
DO - https://doi.org/10.1007/s00192-022-05421-0
M3 - Article
C2 - 36607397
SN - 0937-3462
VL - 34
SP - 1567
EP - 1574
JO - International urogynecology journal and pelvic floor dysfunction
JF - International urogynecology journal and pelvic floor dysfunction
IS - 7
ER -