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EngenderHealth-Led Study Identifies Factors Affecting Outcomes in Fistula Repair

2 OCTOBER, 2012—An unprecedented study led by EngenderHealth has identified key factors affecting the outcome of fistula repair surgeries in developing countries. These factors include pre-operative bladder size, a history of prior repair attempts, and the degree of vaginal scarring and urethral involvement.

In resource-poor settings, fistula is primarily a childbirth-related injury that results in a hole, or abnormal opening, in the birth canal. This causes chronic leakage of urine and/or feces and can lead to stigma and other devastating social and economic consequences.

Until recently, the published evidence base for addressing obstetric fistula has been very limited. To better understand the factors that affect the outcomes of fistula repair, the EngenderHealth-led Fistula Care project conducted a multi-country prospective cohort study, in partnership with local organizations and funded by the U.S. Agency for International Development. The study aimed to identify factors that might predict the outcome of fistula repair (closure of the fistula and incontinence that remains in a woman with a closed fistula), as well as to examine the social and structural factors associated with fistula.

Researchers completed the study between September 2007 and September 2010 at 11 facilities in five countries: Bangladesh, Guinea, Niger, Nigeria, and Uganda. The effort represents one of the largest data collection initiatives to date that assessed fistula repair outcomes and documented the experiences of women with fistula across multiple countries. It is also one of few studies that monitored women after discharge from the repair facility to determine the factors that affect longer-term outcomes.

Data collected through the study have resulted, thus far, in three scientific publications:
  • Factors Influencing Fistula Repair Outcomes in Developing Country Settings: A Systematic Review of the Literature (American Journal of Obstetrics and Gynecology, February 2012)
    Findings: A systematic review finds an insufficient evidence base in the scientific literature on the predictors of fistula repair outcomes, and thus little published evidence to inform clinical practices. Read more.
  • Determinants of Fistula Repair Post-Operative Outcomes: A Prospective Cohort Study (Obstetrics & Gynecology, September 2012)
    Findings: Preoperative bladder size, a history of prior repair attempts, and the degree of vaginal scarring and urethral involvement are all characteristics that can affect the prognosis for fistula repair. Read more.
  • Factors Influencing Choice of Surgical Route of Repair of Urinary Fistula, and the Influence of Route of  Repair on Surgical Outcomes: Findings from a Prospective Cohort Study (British Journal of Obstetrics and Gynecology, October 2012)
    Findings: Using a vaginal route for surgical fistula repair was associated with increased risks of failed fistula closure. While reasons for this remain unclear, our analyses suggest that the risk of failed fistula closure among women repaired vaginally was particularly elevated for those women who met indications for an abdominal repair. Read more.

About EngenderHealth

EngenderHealth is a leading global women’s health organization that is working to ensure that every pregnancy is planned, every child is wanted, and every mother has the best chance at survival. We train health care professionals and partner with governments and communities in more than 20 countries around the world.

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