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Obstetric Vesicovaginal Fistula: Development of a Predictive Score of Failed Surgical Repair

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A Multidisciplinary Approach to Obstetric Fistula in Africa

Part of the book series: Global Maternal and Child Health ((GMCH))

Abstract

There are more than two million cases of genitourinary fistula in sub-Saharan Africa and in Asia. They occur in women living in areas where access to medical care during pregnancy and childbirth is limited or of poor quality and where few hospitals can provide adequate surgical repair. The purpose of this study was to develop a score to predict factors affecting surgical failure of obstetric vesicovaginal fistula (SFOVVF) in the southeastern part of the Haut-Katanga Province in the Democratic Republic of the Congo. We conducted a cross-sectional analytical study of 384 women with obstetric vesicovaginal fistula (OVVF) who had undergone surgery, and performed a bivariate and then a multivariate analysis on the results. The discrimination of the score was assessed using the ROC curve and the C-index while the calibration of the score using Hosmer-Lemeshow’s test. The prevalence of SFOVVF was 17.19% of cases (66/384). The occurrence of fibrotic scarring, presence of two fistulas or more, trans-vesical operative approach, and urethral involvement were predictive factors for SFOVVF. The presence of these four criteria affects a certain number of points; a score <4 points indicates a low risk of SFOVVF, a score between 4 and 5 points defines a moderate risk of SFOVVF, and a score >5 points presents a high risk of SFOVVF. The area under the ROC curve for the score was 0.8759, with a sensitivity of 58%, a specificity of 92%, and a positive predictive value of 91%. This study demonstrated that the number of fistulas, presence of fibrotic scarring, urethral involvement, and trans-vesical approach are predictors of SFOVVF. This logistic model has made it possible to develop a score to identify the SFOVVF risk in a limited resource environment. Therapeutic practice decisions could usefully use this proposed SFOVVF risk prediction score to improve the care of OVVF patients.

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Abbreviations

95% CI:

95% confidence interval

AOR:

Adjusted odds ratio

DHS:

Demographic and Health Survey

DRC:

Democratic Republic of the Congo

OF:

Obstetric fistula

OR:

Odds ratio

OVVF:

Obstetric vesicovaginal fistula

ROC:

Receiver operating characteristic

SFOVVF:

Surgical failure of obstetric vesicovaginal fistula

UNFPA:

United Nations Fund for Population Activities

VVF:

Vesicovaginal fistula

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo

    Joseph B. Nsambi, Prosper L. Kakudji & Jean-Baptiste S. Z. Kakoma

  2. Department of Maternal and Child Health, High Institute of Medical Techniques of Lubumbashi, Lubumbashi, Democratic Republic of the Congo

    Olivier Mukuku

  3. University of Rwanda, Kigali, Republic of Rwanda

    Jean-Baptiste S. Z. Kakoma

Authors
  1. Joseph B. Nsambi
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  2. Olivier Mukuku
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  3. Prosper L. Kakudji
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  4. Jean-Baptiste S. Z. Kakoma
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Corresponding author

Correspondence to Olivier Mukuku .

Editor information

Editors and Affiliations

  1. Office of the Senior Vice President and Provost University of Maryland, College Park, MD, USA

    Laura Briggs Drew

  2. Terrewode Women’s Fund, Eugene, OR, USA

    Bonnie Ruder

  3. Perinatal Pathology Consulting, Atlanta, GA, USA

    David A. Schwartz

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Nsambi, J.B., Mukuku, O., Kakudji, P.L., Kakoma, JB.S.Z. (2022). Obstetric Vesicovaginal Fistula: Development of a Predictive Score of Failed Surgical Repair. In: Drew, L.B., Ruder, B., Schwartz, D.A. (eds) A Multidisciplinary Approach to Obstetric Fistula in Africa. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-031-06314-5_17

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  • DOI: https://doi.org/10.1007/978-3-031-06314-5_17

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-06313-8

  • Online ISBN: 978-3-031-06314-5

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