Abstract
Introduction and hypothesis
Obstetric fistulas have devastating consequences for women. Although surgical repair is largely successful in closing the defect, many women with successful fistula closure report persistent urinary incontinence. Our study is aimed at characterizing incontinence after successful fistula repair and its impact on quality of life.
Methods
This cross-sectional study enrolled women with a history of successful obstetric fistula closure with (n = 51; cases) or without (n = 50; controls) persistent urinary incontinence. Data were collected in Mekelle, Ethiopia, between 2016 and 2018. All cases underwent clinical evaluation and completed questionnaires characterizing the type, severity, and impact of incontinence.
Results
Cases were significantly more likely to have acquired their fistula at an earlier age and with their first vaginal delivery compared with controls. Almost all cases reported both stress (98%) and urgency (94%) incontinence, and half reported constant urinary leakage (49%) despite successful fistula closure. Of cases who completed urodynamic evaluation (n = 22), all had genuine stress incontinence and none had detrusor overactivity. All cases reported moderate to severe (80.4%) or very severe (19.6%) incontinence (measured by ICIQ-SF) and this had a moderate to severe negative impact on their quality of life (as measured by ICIQ-QoL). Although history of suicidal ideation was not significantly different between the groups, among those with suicidal ideation, cases were more likely to report having made a plan and/or attempted to commit suicide.
Conclusions
When urinary incontinence persists after successful fistula closure, it tends to be severe and of mixed etiology and has a significant negative impact on quality of life and mental health.
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Acknowledgements
We would like to thank our partner organizations that made this research possible: the Worldwide Fistula Fund, Hamlin Fistula Ethiopia, Mekelle University College of Health and Sciences, and Healing Hands of Joy.
Funding
Funding for this study was provided by the Worldwide Fistula Fund.
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R.N.: project development and oversight manuscript writing/editing; E.P.: project development and oversight data collection/management/analysis, manuscript writing/editing; L.J.: data collection/management, manuscript writing/editing; A.K.: data management/analysis; C.K.P.: project support, manuscript editing; L.L.W.: project support, manuscript editing; B.G.: data analysis/manuscript editing; S.T.: data collection/management/project oversight A.T.: data collection/management/project oversight M.A.M.: project development and oversight, manuscript editing.
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Nardos, R., Phoutrides, E.K., Jacobson, L. et al. Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women. Int Urogynecol J 31, 2277–2283 (2020). https://doi.org/10.1007/s00192-020-04265-w
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DOI: https://doi.org/10.1007/s00192-020-04265-w