Surgical Treatment for Obstetric Fistula Found Effective

Surgical repair provides good long-term outcomes in women suffering from an obstetric fistula, according to a new study.

Researchers from the Hamlin Fistula Center (Bahir Dar, Ethiopia), a dedicated unit for treating women with obstetric fistula in northern Ethiopia, conducted a prospective study of all women admitted to the center suffering from vesicovaginal (VF) and rectovaginal fistulae (RVF). A total of 390 women were asked to return for a follow-up appointment six months after surgical treatment. The women were questioned at discharge and at follow-up appointment, using a standardized questionnaire, and an examination was performed. The information was then entered into a database.

The researchers found that only eight women (2.1%) had a failed VF repair, but 95 women (24.3%) in whom the fistula appeared to be closed still had urethral incontinence. Twenty-two of the 141 women who were cured at discharge and returned for follow-up came back leaking with an incontinence grade of 2-4. Just over half (53%) of 92 women who were discharged with urethral incontinence returned with the same incontinence grade and 44% returned with their incontinence score improved or with their fistula now healed or retention resolved. However, 15% of the women cured at discharge returned with their incontinence grade worse or with urinary retention or fistula recurrence. By six months after repair, one-third of women had resumed sexual activity (without pain in 90%) and 83% reported that the operation had at least moderately improved their quality of life. The study was published in the November 2008 issue of BJOG: An International Journal of Obstetrics and Gynaecology.

"Continence gains immediately after the operation are largely maintained at six months. There is one notable finding that some women have a recurrence of their fistula after being discharged cured, and this certainly needs to be looked at with the view to improving this outcome,” said lead author Andrew Browning, M.D. "We have made steps to decrease the incontinence rates with the adoption of some new surgical techniques. This has resulted in a drop from 33-55% to 23% in short-term incontinence rates. Further research needs to be done to decrease this rate even further, but any developments need to be simple and cheap for the developing world setting.”

Obstetric fistula is a severe medical condition in which a fistula develops between the rectum and vagina (rectovaginal fistula) or between the bladder and vagina (vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available. The fistula usually develops when a prolonged labor presses the unborn child so tightly in the birth canal that blood flow is cut off to the surrounding tissues, which necrotize and eventually rot away. More rarely, the injury can be caused by female genital cutting, poorly performed abortions, pelvic fractures, or rape.

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