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Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study
Author(s) -
Kopp DM,
Bengtson AM,
Tang JH,
Chipungu E,
Moyo M,
Wilkinson J
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14505
Subject(s) - medicine , vesicovaginal fistula , prospective cohort study , fistula , cohort , cohort study , demographics , receiver operating characteristic , surgery , obstetrics , gynecology , demography , sociology
Objective Determine whether a 1‐hour pad test at discharge can identify continence status within 120 days of obstetric vesicovaginal fistula ( VVF ) repair. Design Prospective cohort study. Setting Fistula Care Centre in Lilongwe, Malawi. Population Women with VVF who underwent repair between January 2012 and December 2014. Methods Data on demographics, obstetric history, physical exam findings, operative management, postoperative findings, and follow up evaluations were collected on women with VVF repair. Main outcome measures Sensitivity, specificity, positive and negative predictive values ( PPV and NPV ), and a receiver operating curve ( ROC ) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow up. Results After VVF repair, 346 women had a 1‐hour pad test performed at the time of hospital discharge and completed follow up within 120 days of repair. Of these, 79.8% ( n = 276) were completely continent, whereas 20.2% ( n = 70) had some degree of incontinence. The sensitivity and specificity of a negative 1‐hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5‐g threshold demonstrates a high predictive value ( PPV = 94.0%, 95% CI 90.0–96.9) in detecting women with continence after repair. Conclusions At the 1.5‐g threshold, a negative pad test at discharge identifies 94% of women who will remain continent after VVF repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow up after repair is difficult. Tweetable abstract A negative pad test after repair is associated with continued continence at follow up.