The Characteristics and Clinical Outcomes of Patients Undergoing Repeat Repair for Obstetric Fistula at Kenyatta National Hospital

Abstract

Introduction: The mainstay of managing obstetric fistula (OF) is surgical. Primary closure of an OF is usually successful but in some women this may persist necessitating secondary closure or repeat repair. Women who undergo repeat repair have certain characteristics majorly as a result of the type of fistula, extent of injury or unsuccessful closure of the primary fistula. Most studies include patients that are undergoing both primary and secondary repair This study aims at describing the clinical characteristics and clinical outcomes associated with repeat OF repairs, with the aim to improve their management. Objective: To describe the socio-demographic and clinical characteristics of patients undergoing repeat repair for obstetric fistulae at the KNH between 1st May 2010 and 30th June 2015 and the clinical outcomes following repeat repair. Methodology: Out of a total of 723 patients with obstetric fistula operated during the period, 249 (34%) underwent repeat repairs. Two hundred and three records (102 VVF and 101 RVF) of patients who underwent repeat repairs were consecutively selected. Descriptive data was presented in tables of means and medians; further analysis was done using the student t test for comparing means and chi square tests for association between patient characteristics and outcomes. A p value of < 0.05 was taken to be statistically significant. Results: Overall, 60% of the study participants were married and just about two thirds had attained some basic level of education. The most common type of VVF was type IIAa at 44% while type IIb was the commonest type of RVF at 89.9%. The mean age for VVF development was 22.3 years while for the RVF was 25.5 years. This was statistically significant with a p value <001. Delivery via caesarean section was higher in those with VVF (55.9%) as compared to those with RVF (7.9%). Most of the VVF were small at 55.7% and had at least one prior repair at 59.8%. For the RVF patients, 70.6% were medium in size while 40.2% had one prior repair. Residual incontinence was at 36.6% of patients with VVF. Patients with RVF had 100% recovery. Conclusion: Specific policy guidelines by stakeholders of obstetric fistula should be developed into prevention and management of associated complications.