Reduction in the incidence of stress incontinence complicating fistula repair

The results of treatment of 11 gynaecological fistulae and 150 obstetrical fistulae over a period of 6¼ years is presented. Postoperative stress incontinence was the most serious complication. Its incidence following repair of obstetrical fistulae has been reduced to 7.3 per cent in this series. Meticulous technique, combining the appropriate operation for bladder neck reinforcement with the initial flap-splitting repair, contributed to the low incidence of postoperative stress incontinence. Suprapubic operations were utilized in 20 cases (13.3 per cent). Gross vesical contraction associated with incontinence in 7 cases responded to ileocystoplasty or sigmoidocystoplasty. The final functional cure rate in the series was 873 per cent. Closure was accomplished in about 95 per cent of fistulae. In 8 cases closure was unsuccessful; 4 of these were inoperable. There was I death due to endotoxic shock after ureterosigmoidostomy.