Premium
Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study
Author(s) -
Kopp DM,
Tang JH,
Bengtson AM,
Chi BH,
Chipungu E,
Moyo M,
Wilkinson J
Publication year - 2019
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 - 10.1111/1471-0528.15546
Subject(s) - medicine , urinary incontinence , quality of life (healthcare) , depression (economics) , vesicovaginal fistula , cohort study , obstetrics , gynecology , surgery , fistula , nursing , economics , macroeconomics
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.