Predicting the risk of failure of closure of obstetric fistula and residual urinary incontinence using a classification system

The aim of this study is to assess the possibility of predicting the risk of failure of closure and post-fistula urinary incontinence. Women attending the fistula clinics were assessed pre-operatively, and fistulae were staged prospectively, using a previously published classification system. Assessment for fistula closure and residual urinary incontinence was performed, prior to discharge. Of the 987 women who were assessed, 960 had successful closure of their fistulae. Of those with successful closure, 229 complained of urinary incontinence following surgery. Women with fistulae located closest to the external urinary meatus had the highest rate of urinary incontinence following fistula closure. Women with significant vaginal scarring and circumferential fistulae also had significantly higher rates of urinary incontinence and higher risk of failure of closure. The classification used is able to predict women at risk of post-fistula urinary incontinence and failure of closure.