Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam Medical Center, Room H4-240, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Int Urogynecol J. 2023 Jul;34(7):1567-1574. doi: 10.1007/s00192-022-05421-0. Epub 2023 Jan 6.
Predictors of surgical outcomes in patients with an obstetric fistula who have been operated before should be identified in order to guide surgical strategy and optimize counseling of the patient.
This retrospective study is aimed at identifying predictors of outcomes for repeat surgery in 346 patients who had been operated on before for an obstetrics fistula at the Fistula Care Center (FCC) in Lilongwe, Malawi. Repeat cases were only undertaken by advanced and expert surgeons. The primary outcome was successful anatomical closure, based on a negative postoperative dye test. The secondary outcomes involved urinary continence, based on a patient-reported questionnaire and an objective 1-h pad weight test. Logistic regression models were used to test the predictors for statistical significance.
Successful fistula closure was achieved in 288 (83%) patients and continence was achieved in 185 (64%) patients after the first repeat attempt at the FCC. Lack of urethral involvement (Goh classification: proximity to the urethra) was shown to be a good predictor of the outcomes: fistula closure and subjective and objective continence.
Absence of urethral involvement is an independent predictor for successful outcomes in repeat surgery for obstetric fistulas. Even in the hands of an expert surgeon, the risk of another failure in achieving anatomical closure or subjective or objective continence is between 4 and 5 times higher than when the urethra is not involved.
为了指导手术策略并优化患者咨询，应该确定先前接受过产科瘘管手术的患者的手术结果的预测因素。
本回顾性研究旨在确定 346 名在马拉维利隆圭瘘管护理中心（FCC）因产科瘘管而接受过先前手术的患者再次手术结果的预测因素。重复手术仅由高级和专家外科医生进行。主要结局是基于术后染料试验阴性的解剖学成功闭合。次要结局包括尿控，基于患者报告的问卷和客观的 1 小时垫重试验。使用逻辑回归模型检验预测因素的统计学意义。
在 FCC 的首次重复尝试中，288 名（83%）患者成功关闭瘘管，185 名（64%）患者实现尿控。尿道未受累（Goh 分类：靠近尿道）被证明是手术结果的良好预测因素：瘘管闭合以及主观和客观尿控。
尿道未受累是产科瘘管重复手术成功结局的独立预测因素。即使在专家外科医生手中，与尿道未受累相比，实现解剖学闭合或主观或客观尿控的再次失败的风险要高出 4 到 5 倍。
