Characteristics Associated with Failure of Obstetric Fistula Surgery

INTRODUCTION AND HYPOTHESIS: Quality of life can significantly improve following successful surgical repair of obstetric fistula; however, these surgeries may be technically challenging. There are limited consensus data regarding optimal fistula closure techniques and perioperative management. The objective of this study was to identify clinical and anatomical characteristics associated with failure of obstetric vesicovaginal/urethrovaginal fistulas (VVaF/UVaF) closure. MATERIALS AND METHODS: In this retrospective cohort study, medical records of patients following VVaF/UVaF surgery at a single fistula center in Niger between 2022 and 2024 were identified. Clinical and demographic data were collected. Successful fistula closure was defined as water-tight visually assessed closure of fistula at discharge from the fistula center. Multivariable logistic regression was used to identify independent factors associated with closure failure. RESULTS: Of 125 women, 28 (22.4%) had failure of fistula closure. Mean age (SD) was 31.2 (9.78) years and median (interquartile range [IQR] parity 2 (0-4), with no difference between groups (all p > 0.05). Multivariable logistic regression adjusting for age resulted in an aOR (95% CI) for the number of previous surgeries of 1.37 (1.06, 1.75), and Goh's fibrosis level 2 vs 1 of 2.70 (1.04, 7.14) and 3 vs 1, 4.55, (1.04, 20.0). CONCLUSIONS: In this population of women undergoing obstetric VVaF/UVaF repair, patients having undergone more surgeries and those with greater tissue fibrosis had greater odds of failed fistula closure. This emphasizes the importance of the initial fistula repair surgery as the best chance for fistula closure in these patients sustaining life-changing pelvic floor injury.