Predictors of Successful Obstetric Fistula Repair at the National Obstetric Fistula Centre, Abakaliki, Nigeria

Predictors of successful obstetric fistula repair

Abstract

BACKGROUND: Obstetric fistula is a major public health problem in Nigeria and other low- and middle-income countries. Surgical repair is the mainstay of treatment. The success of repair however depends on several factors.

OBJECTIVE: To determine the predictors of successful obstetric fistula repair. METHODOLOGY: It was a prospective cohort study carried out over a 6-month period. 120 consecutive, eligible and consenting patients were recruited and assessed for sociodemographic, obstetric and fistula characteristics, perioperative factors and outcomes of surgery. Outcomes at discharge were categorized into fistula closed with continence, fistula closed with residual incontinence or failed repair. Only fistula closed with continence was considered successful repair. Data was analyzed using the SPSS version 24.0. Test of associations was done using Chi-square and Fischer’s exact tests. A P-value less than 0.05 was considered statistically significant.

RESULTS: The mean age of the women was 30.4 + 6.6 years. 83.4% of patients had their fistulas closed with continence while 8.3% had their fistulas closed with residual incontinence and 8.3% had failed repair. Successful repair was more in women who had caesarean delivery than those who had vaginal delivery (98.5% vs 63.2%, P=0.000). It was more in fistulas without urethral involvement than those with urethral involvement (100% vs 61.2%, P=0.000). All patients with combined fistula had failed repair (P=0.000).  Successful repair was seen in fistulas that were small (100%), those with no vaginal scarring (100%), medium urethral length (90.9%) and no previous repair (94.9%), (P=0.01, P=0.00, P=0.00, P=0.00 respectively). It was also more in patients who had no post-operative complications (P=0.018). Patients who had catheter for 14 days had more successful repairs than those with those who had catheter for 21 days (94.5% vs 43.3%, P=0.000). Sociodemographic characteristics had no influence on the outcome of repair.

CONCLUSION: The predictors of successful repair are Caesarean delivery, absence of urethral involvement, mild or no vaginal fibrosis, no previous repair, moderate size fistulas, urethral length greater than 2cm, catheterization for 2 weeks and uneventful post-operative period. These factors should be considered during pre-operative preparation and counseling of patients.