Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study

OBJECTIVE: We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously. DESIGN: Prospective cohort study. SETTING: Fistula Care Centre in Lilongwe, Malawi. POPULATION: Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment. METHODS: Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire. MAIN OUTCOME MEASURES: Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation. RESULTS: Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR = 2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence. CONCLUSIONS: While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group. TWEETABLE ABSTRACT: Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.