TITLE:
Determinants of Outcomes and Prognosis Score in Obstetric Vesico-Vaginal Fistula Repair
AUTHORS:
Leon Mubikayi, David O. Matson, Vicky Lokomba, Justin Mboloko, Jean Patrick Kamba, Rahma Tozin
KEYWORDS:
Obstetrical Fistula, Repair, Outcomes, Prognosis Score
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.7 No.7,
July
31,
2017
ABSTRACT: An
estimated 2 million women living in countries with limited resources currently
have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the
necrosis that occurs with obstructed labor. We evaluated factors readily
assessed by the examining practitioner in a consecutive case series of surgical
repairs of obstetrical fistulae, for the ability of those factors to stand as a
prognostic guide, in a clinical score. Objectives: To identify the predictors
of surgical repair outcomes and establish a Score combining these different determinants
to facilitate the care of obstetric fistula. Methods: We conducted a
multicentric prospective study between 2011 and 2014 in Democratic Republic of
the Congo (DRC).
Outcomes: We measured 3 months post-surgery
in a series of 483 patients with obstetrical fistula repaired by the same
surgeon included closure and failure appreciated by dye test. Multivariable
generalized estimating equation models were used to generate adjusted odd
ratios (OR) and 95% confidence intervals (CIs). The scores ranging
from 3 to 14 were established from the outcomes determinants identified. Results: In
total, 483 women were enrolled, and 390 cases
were at their first surgery and were included in the obstetric fistula (OF)
prognosis score and classification. Their mean age was 35 years at the time of
the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was
primigravida. Mean duration between onset of the fistula and surgical treatment
was 8 years. In 24%, the fistula patients lived separated from their partners. Overall
closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p 0.01), big
fistula size (0.01),
small distance from fistula to external urethral meatus (0.01) and
prior surgery (p 0.48)
predicted failed fistula closure. A clinical score ranging from 3 to 14 points
is a prognostic score with a range of 1 to 4 for the distance between the
fistula and the external meatus and the size, and a scale of 1 to 6 for
fibrosis. Conclusions: This study demonstrated that the marked
vaginal scarring; large fistula size and distance to urethral meatus are
predictors for unsuccessful fistula repair. Due to the lack of a standard
classification that is never unanimous among the different surgeons, this
prognostic score allows the combination of the different determinants assessing the
chances of success and can help the practitioners to orient the patients towards
the determined skill scale to take care of the patients.