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Background: Obstetric fistula remains a debilitating maternal health condition, particularly in low-income countries. The Mainz II pouch, a continent urinary diversion, is a last-resort surgical option for irreparable fistulas. Despite surgical success, little is known about long-term psychosocial outcomes in such settings. This study aimed to explore the long-term lived experiences and quality of life outcomes of women in rural Uganda who underwent the Mainz II pouch procedure for incurable obstetric fistula, with a focus on post-surgical equity and adaptation. Methods: This qualitative study, informed by biopsychosocial and feminist political economy frameworks, utilized in-depth interviews guided by a culturally adapted World Health Organization Quality of Life (WHOQOL-BREF) tool. Six women with obstetric fistula and one with a non-obstetric urological condition were purposively sampled and interviewed 5– 14 years post-surgery. Thematic analysis using NVivo 12 followed a rigorous six-phase approach, with intercoder reliability (κ=0.82) ensuring analytical rigor. Results: Participants reported restored continence and improved physical functionality. However, ongoing nocturnal incontinence, psychological distress, and social stigma persisted. Younger women (23– 33 years) adapted better compared to older counterparts (52– 70 years), who faced challenges such as social isolation. Conclusion: Mainz II pouch surgery offers physical relief but insufficient psychosocial recovery. To address systemic inequities in post-fistula care, health systems in low-income countries must prioritize integrated, context-sensitive rehabilitation services that include mental health, sexual health, and long-term follow-up. Plain Language Summary: This study explores the lived experiences of women in rural Uganda who underwent a rare surgery called the Mainz II pouch for severe childbirth injuries that could not be repaired by standard methods. Although the surgery successfully stopped constant urine leakage and enabled women to resume daily activities, they continued to experience emotional distress, nighttime wetting, and community stigma years after surgery. Younger women adapted more easily than older women. Crucially, none of the women had received ongoing care from their local health centers or family doctors after their surgery. These findings suggest that Uganda’s primary care system must be strengthened to provide long-term mental health support, sexual health counseling, and regular medical checks for these women. Keywords: obstetric fistula, quality of life, Mainz II pouch, Uganda, urinary diversion, psychosocial health
Kirya et al. (Fri,) studied this question.