Obstetric fistula repair: a guide to patient selection

Objective. The World Health Organization has advocated for the classification of obstetric fistula into simple and complex cases. This study set out to design a guide to patient selection to facilitate the attainment of this goal. Materials and Methods. Associated risk factors were identified and analyzed among a cross section of women who had complex obstetric vesicovaginal fistulas. Results. The risk factors that were identified to affect significantly the prospect of cure following repair were large size of the fistula greater than 4 cm, associated urethral loss and adherence of the fistula to the pubic bone. Others were three or more previous attempts at repair, moderate to severe degree of scarring at the fistula margin, combined vesicovaginal and rectovaginal fistulas and the proximity of the fistula margin to the ureter. Each identified risk factor was allocated a score ranging from 0 to 4 depending on the adjudged capacity of the factor to affect the prospect of cure following repair. Conclusions. Any case of vesicovaginal fistula with a total score of 4 or less using the proposed prognostic scoring system was adjudged suitable for repair by gynaecological or general surgeons, who have been trained on fistula repair with a significant prospect of success.