Nembunzu Dolores, Mayemba Naomie, Sidibé Sidikiba, Grovogui Fassou Mathias, Aussak Brian Tena Tena, Banze Kyongolwa Don Félicien, Camara Bienvenu Salim, Tripathi Vandana, Delamou Alexandre
Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo.
Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea.
Front Glob Womens Health. 2022 Jun 24;3:896991. doi: 10.3389/fgwh.2022.896991. eCollection 2022.
Despite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care project in the Democratic Republic of Congo (DRC).
This was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence.
Overall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1-6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33-550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10-9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02-45.21).
Prior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.
尽管膀胱阴道瘘成功闭合后的闭合率较高，但残余尿失禁仍是一个常见问题。本研究的目的是确定在刚果民主共和国瘘管护理项目支持的地点，瘘管成功闭合的女性中与残余尿失禁相关的因素。
这是一项回顾性队列研究，使用从2017年至2019年在刚果民主共和国瘘管护理加强项目支持的三家医院接受瘘管手术的女性病历中提取的常规数据。我们分析了出院时瘘管已闭合的女性子样本中与残余尿失禁相关的因素。我们收集了社会人口统计学、临床、妇产科特征和病例管理的数据。进行单因素和多因素分析以确定与残余尿失禁相关的因素。
总体而言，718例修复后瘘管闭合出院的女性中有31例（4.3%；95%可信区间：3.1 - 6.1）存在残余尿失禁。这些有残余尿失禁的女性中确定的主要原因是尿道排尿（6例）、尿道短（6例）、严重纤维化（3例）和膀胱过小（2例）。与潘齐医院（1.7%）相比，在治愈非洲医院（6.6%）和圣约瑟夫医院（3.7%）接受修复的女性中，残余尿失禁的患病率更高。与持续性尿失禁几率增加相关的因素是治愈非洲医院的修复地点（调整后比值比：54.18；95%可信区间：5.33 - 550.89）、任何既往手术（调整后比值比：3.17；95%可信区间：1.10 - 9.14）和经阴道手术途径（调整后比值比：6.78；95%可信区间：1.02 - 45.21）。
既往手术和修复地点是瘘管闭合后残余尿失禁的主要预测因素。需要对尿失禁进行早期检测和管理，并进行进一步研究以了解不同地点对持续性尿失禁的影响。
