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01-11-2020 | Stress Incontinence | Original Article

Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women

Authors: Rahel Nardos, Elena K. Phoutrides, Laura Jacobson, Allyson Knapper, Christopher K. Payne, L. Lewis Wall, Bharti Garg, Senait Tarekegn, Almaz Teamir, Melaku Abriha Marye

Published in: International Urogynecology Journal | Issue 11/2020

Abstract

Introduction and hypothesis

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.

Methods

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.

Results

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.

Conclusions

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.

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Title: Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women
Authors: Rahel Nardos
Elena K. Phoutrides
Laura Jacobson
Allyson Knapper
Christopher K. Payne
L. Lewis Wall
Bharti Garg
Senait Tarekegn
Almaz Teamir
Melaku Abriha Marye
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keywords: Stress Incontinence
Urinary Incontinence
Urinary Incontinence
Published in: International Urogynecology Journal / Issue 11/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04265-w

At a glance: The STEP trials

Springer Medicine

Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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