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BJOG. 2019 Jun;126(7):926-934. doi: 10.1111/1471-0528.15546. Epub 2018 Dec 27.

Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study.

Author information

1
UNC Project-Malawi, Lilongwe, Malawi.
2
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
3
Department of Epidemiology, Brown University, Rhode Island, USA.
4
Fistula Care Center, Lilongwe, Malawi.
5
Department of Obstetrics and Gynaecology, Malawi College of Medicine, Blantyre, Malawi.
6
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.

Abstract

OBJECTIVE:

We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously.

DESIGN:

Prospective cohort study.

SETTING:

Fistula Care Centre in Lilongwe, Malawi.

POPULATION:

Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment.

METHODS:

Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire.

MAIN OUTCOME MEASURES:

Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation.

RESULTS:

Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR = 2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence.

CONCLUSIONS:

While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group.

TWEETABLE ABSTRACT:

Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.

KEYWORDS:

Africa; Malawi; depression; obstetric fistula; quality of life; residual incontinence

PMID:
30461170
PMCID:
PMC6510632
[Available on 2020-06-01]
DOI:
10.1111/1471-0528.15546
[Indexed for MEDLINE]

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