Worldwide Fistula Fund, Oregon Health & Science University/Kaiser Permanente, Mail code: L466, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
Contra Costa Regional Medical Center, Martinez, CA, USA.
Int Urogynecol J. 2020 Nov;31(11):2277-2283. doi: 10.1007/s00192-020-04265-w. Epub 2020 Mar 16.
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.
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.
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.
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.
产科瘘管对女性造成了毁灭性的后果。尽管手术修复在很大程度上成功地封闭了缺陷，但许多成功修复瘘管的女性仍报告存在持续性尿失禁。我们的研究旨在描述成功修复瘘管后尿失禁的特征及其对生活质量的影响。
这项横断面研究纳入了埃塞俄比亚梅克尔市 51 例（病例组）和 50 例（对照组）有成功产科瘘管修复史且伴有或不伴有持续性尿失禁的女性。研究数据于 2016 年至 2018 年期间收集。所有病例均接受了临床评估，并完成了问卷，以描述失禁的类型、严重程度和对生活质量的影响。
与对照组相比，病例组发生瘘管的年龄更小，且首次分娩时即发生瘘管的可能性更大。几乎所有病例均报告存在压力性（98%）和急迫性（94%）失禁，尽管瘘管已成功修复，但仍有一半报告存在持续性漏尿（49%）。在完成尿动力学评估的病例中（n=22），所有病例均存在真性压力性尿失禁，无一例存在逼尿肌过度活动。所有病例报告存在中重度（80.4%）或重度（19.6%）失禁（根据 ICIQ-SF 评估），这对其生活质量造成了中重度（根据 ICIQ-QoL 评估）的负面影响。尽管两组患者的自杀意念史无显著差异，但有自杀意念的病例中，更有可能报告已制定自杀计划和/或尝试自杀。
当成功修复瘘管后仍存在尿失禁时，其往往较为严重，病因复杂，对生活质量和心理健康有重大负面影响。
