Twelve Years of Managing Female Urogenital Fistula in Uganda: Characteristics, Repair Outcomes, and Predictors for Success in a Multicentre Cohort Study

Abstract

INTRODUCTION AND HYPOTHESIS: To describe the characteristics and aetiology of urogenital fistula, and to determine the predictors for successful repair. METHODS: We conducted a multicentre retrospective cohort study using prospectively collected data of women who underwent urogenital fistula repair at four regional repair centres between 2010 and 2021. The fistulae were classified as ischaemic (urethrovaginal and vesicovaginal), iatrogenic (vesico-cervical, vesico-uterine, vaginal vault fistula, and ureteric fistula) and congenital. The patients were followed up at 3 months postoperatively to assess surgical outcomes. Successful repair was defined as fistula closure with urinary continence, while unsuccessful repair included failed fistula closure or residual urethral incontinence. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for predictors of successful repair. RESULTS: A total of 510 women were included. The mean age was 32.7 ± 12.5 years. The most common fistula type was urethrovaginal (34.9%). Successful repair was achieved in 80.8% (95% CI 77-84). Women with urethrovaginal fistula (aRR 0.18; 95% CI 0.1-0.4; p < 0.001), previous fistula repair (aRR 0.44; 95% CI 0.25-0.79; p = 0.005), and those who were divorced (aRR 0.47; 95 CI 0.27-0.83; p = 0.009) were less likely to have successful repair. In contrast, grand multiparity was associated with a higher likelihood of success (aRR 2.4; 95% CI 1.08-5.2; p = 0.03). CONCLUSION: Fistula repair outcomes were favourable, with a high success rate. Urethrovaginal fistula, previous repair, and divorce were associated with lower likelihood of success. These findings highlight the need for careful patient selection and specialised expertise in the management of complex fistulae.