Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women
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ORIGINAL ARTICLE
Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women Rahel Nardos 1 & Elena K. Phoutrides 2 & Laura Jacobson 3 & Allyson Knapper 4 & Christopher K. Payne 5 & L. Lewis Wall 6 & Bharti Garg 7 & Senait Tarekegn 8 & Almaz Teamir 9 & Melaku Abriha Marye 10 Received: 21 December 2019 / Accepted: 12 February 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Obstetric fistulas have devastating consequences for women. Although surgical repair is largely successful in closing the defect, many women with successful fistula closure report persistent urinary incontinence. Our study is aimed at characterizing incontinence after successful fistula repair and its impact on quality of life. Methods This cross-sectional study enrolled women with a history of successful obstetric fistula closure with (n = 51; cases) or without (n = 50; controls) persistent urinary incontinence. Data were collected in Mekelle, Ethiopia, between 2016 and 2018. All cases underwent clinical evaluation and completed questionnaires characterizing the type, severity, and impact of incontinence. Results Cases were significantly more likely to have acquired their fistula at an earlier age and with their first vaginal delivery compared with controls. Almost all cases reported both stress (98%) and urgency (94%) incontinence, and half reported constant urinary leakage (49%) despite successful fistula closure. Of cases who completed urodynamic evaluation (n = 22), all had genuine stress incontinence and none had detrusor overactivity. All cases reported moderate to severe (80.4%) or very severe (19.6%) incontinence (measured by ICIQ-SF) and this had a moderate to severe negative impact on their quality of life (as measured by ICIQ-QoL). Although history of suicidal ideation was not significantly different between the groups, among those with suicidal ideation, cases were more likely to report having made a plan and/or attempted to commit suicide. Conclusions When urinary incontinence persists after successful fistula closure, it tends to be severe and of mixed etiology and has a significant negative impact on quality of life and mental health. Keywords Obstetric fistula . Urogynecology . Urinary incontinence . Ethiopia * Rahel Nardos [email protected] 1
Worldwide Fistula Fund, Oregon Health & Science University/ Kaiser Permanente, Mail code: L466, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
2
Contra Costa Regional Medical Center, Martinez, CA, USA
3
School of Public Health, OHSU-PSU, Portland, OR, USA
4
School of Medicine, Oregon Health & Science University, Portland, OR, USA
5
Vista Urology and Pelvic Pain Partners, Worldwide Fistula Fund, San Jose, CA, USA
6
Washington University, Worldwide Fistula Fund, St Louis, MI, USA
7
Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
8
Healing Hands of Joy, Mekelle, Ethiopia
9
Hamlin Fistula Center, Mekelle, Ethiopia
10
Obstetrics and Gynecology, Haml
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