Paluku Justin, Bruce Phoebe, Kamabu Eugénie, Kataliko Benjamin, Kasereka Jonathan, Dube Annie
Department of Obstetrics and Gynecology, HEAL Africa Tertiary Hospital, Goma, North Kivu, Democratic Republic of Congo.
Department of Obstetrics and Gynecology, University of Goma (UNIGOM), Goma, North Kivu, Democratic Republic of Congo.
Int J Womens Health. 2021 Oct 29;13:1025-1031. doi: 10.2147/IJWH.S332040. eCollection 2021.
To describe the demographics and evaluate the repair of childbirth-associated injuries leading to incontinence in patients in remote Democratic Republic of Congo (DRC).
Four surgical outreach campaigns were organised between March 2018 and October 2019. These campaigns specifically targeted women with incontinence secondary to childbirth-associated injuries. Patients were recruited on a voluntary basis, and locations included Katako-kombe (Sankuru province), Wamba (Haut Uelé province), Karawa (North Ubangi province) and Kipaka (Maniema province). Necessary care was provided along with informal teaching with local healthcare professionals.
A total of 481 patients,14-71 years old with a mean of 32 years of age, were included in this study. The average duration of incontinence associated with a childbirth injury was 6.8 years. Vesicovaginal fistulas (277/481; 57.6%) and perineal tears (148/481; 30.8%) were predominant, while the combination of vesicovaginal and rectovaginal fistulas were seen in only 5 (1.0%) patients. Vaginal delivery (259/481; 53.9%), caesarean section (120/481; 25.0%) and laparotomy (hysterectomy) (102/481; 21.2%) were identified as the causes of the fistulas treated during the surgical campaign. Vesicovaginal fistulas were more likely to require complex repairs, as compared to rectovaginal fistulas and perineal tears (-value <0.0001). As well, vesicovaginal fistulas were less likely to result in successful resolution of the incontinence when compared to rectovaginal fistulas and perineal tears (-value < 0.0001).
Vesicovaginal fistulas are predominant among childbirth injuries encountered in remote DRC with poorly managed vaginal deliveries being the leading cause. Cure rate of fistulas and perineal tears is high during outreach campaigns; however, long-term follow-up is limited. There remains a need to train and mentor rural medical professionals in the DRC on adequate management of obstetric emergencies.
描述刚果民主共和国（DRC）偏远地区因分娩相关损伤导致尿失禁患者的人口统计学特征，并评估此类损伤的修复情况。
在2018年3月至2019年10月期间组织了四次外科外展活动。这些活动专门针对因分娩相关损伤继发尿失禁的女性。患者自愿参与，地点包括卡塔科 - 孔贝（桑库鲁省）、万巴（上韦莱省）、卡拉瓦（北乌班吉省）和基帕卡（马尼埃马省）。在提供必要护理的同时，还对当地医疗专业人员进行了非正式教学。
本研究共纳入481例患者，年龄在14 - 71岁之间，平均年龄为32岁。与分娩损伤相关的尿失禁平均持续时间为6.8年。膀胱阴道瘘（277/481；57.6%）和会阴撕裂（148/481；30.8%）最为常见，而膀胱阴道瘘和直肠阴道瘘合并出现的仅5例（1.0%）。阴道分娩（259/481；53.9%）、剖宫产（120/481；25.0%）和剖腹手术（子宫切除术）（102/481；21.2%）被确定为外科活动中治疗的瘘管的病因。与直肠阴道瘘和会阴撕裂相比，膀胱阴道瘘更可能需要复杂的修复（P值<0.0001）。同样，与直肠阴道瘘和会阴撕裂相比，膀胱阴道瘘导致尿失禁成功解决的可能性较小（P值<0.0001）。
在刚果民主共和国偏远地区，分娩损伤中膀胱阴道瘘占主导，阴道分娩管理不善是主要原因。外展活动期间瘘管和会阴撕裂的治愈率较高；然而，长期随访有限。刚果民主共和国仍需要培训和指导农村医疗专业人员如何妥善处理产科急诊。
