Author(s): Barone MA, Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, , Barone MA, Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH,
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Abstract OBJECTIVE: To determine predictors of fistula repair outcomes 3 months postsurgery. METHODS: We conducted a multicountry prospective cohort study between 2007 and 2010. Outcomes, measured 3 months postsurgery, included fistula closure and residual incontinence in women with a closed fistula. Potential predictors included patient and fistula characteristics and context of repair. Multivariable generalized estimating equation models were used to generate adjusted risk ratios (RRs) and 95\% confidence intervals (CIs). RESULTS: Women who returned for follow-up 3-month postsurgery were included in predictors of closure analyses (n=1,274). Small bladder size (adjusted RR 1.57, 95\% CI 1.39-1.79), prior repair (adjusted RR 1.40, 95\% CI 1.11-1.76), severe vaginal scarring (adjusted RR 1.56, 95\% CI 1.20-2.04), partial urethral involvement (adjusted RR 1.36, 95\% CI 1.11-1.66), and complete urethral destruction or circumferential defect (adjusted RR 1.72, 95\% CI 1.33-2.23) predicted failed fistula closure. Women with a closed fistula at 3-month follow-up were included in predictors of residual incontinence analyses (n=1,041). Prior repair (adjusted RR 1.37, 95\% CI 1.13-1.65), severe vaginal scarring (adjusted RR 1.35, 95\% CI 1.10-1.67), partial urethral involvement (adjusted RR 1.78, 95\% CI 1.27-2.48), and complete urethral destruction or circumferential defect (adjusted RR 2.06, 95\% CI 1.51-2.81) were significantly associated with residual incontinence. CONCLUSION: The prognosis for genital fistula closure is related to preoperative bladder size, previous repair, vaginal scarring, and urethral involvement.
This article was published in Obstet Gynecol
and referenced in Tropical Medicine & Surgery