Characterizing persistent urinary incontinence after successful fistula closure: the Uganda experience

Area of Science:

• Urology
• Obstetrics & Gynecology
• Public Health

Background:

• Obstetric fistula is a severe childbirth injury with a high rate of persistent urinary incontinence (16-55%) even after successful surgical closure.
• Understanding the type, severity, and quality of life impact of this persistent incontinence is crucial for affected women.

Purpose of the Study:

• To assess the type and severity of persistent urinary incontinence following successful obstetric fistula repair.
• To evaluate the impact of this persistent incontinence on the quality of life among Ugandan women.

Main Methods:

• A cross-sectional study in Uganda (2017-2019) comparing women with persistent incontinence (cases, N=36) and those without (controls, N=52) after fistula repair.
• Data collection included semistructured questionnaires, clinical evaluations, 2-hour pad tests, and validated incontinence severity tools for low-literacy populations.

Main Results:

• Women with persistent incontinence were younger at fistula onset, more likely to have had multiple fistula surgeries, and had a higher rate of planned home births.
• High prevalence of stress (67%), urgency (47%), and mixed (47%) incontinence was observed, with over half rating their condition as 'very severe'.
• Objective tests confirmed severe incontinence, with significant pad weight changes and high urinary frequency. More severe incontinence correlated with a greater negative impact on quality of life.

Conclusions:

• Severe persistent urinary incontinence, including stress and urgency types, is highly prevalent in women post-obstetric fistula repair.
• The severity of incontinence significantly worsens the quality of life for these women, underscoring the need for improved post-surgical management and support.