The high incidence of obstetric fistulas in sout east of India and in Sub-Saharan Africa result mostly from poor management of the pregnant woman.
Several factors may contribute to persistent incontinence after surgical fistula treatment.(1)
The aim is to Determine the factors involved in the recurrence of obstetric fistulas post-surgical repairs.

This is a cross-sectional study which took place from October 1 to 31, 2019, using a convenience sample of 62 women diagnosed with obstetric fistulas. Data were obtained from patients’ registers from outpatient consultations, emergency department as well as obstetric records, and any other hospital registers. These documents made possible to obtain necessary information on the women from their admission to the various centers of provenance until the day of the campaign. We used the interviews to supplement socio-demographic and clinical data. The physical examination included gynecological and urological assessments(2). Fistula types were determined using Kees Waldjik classification (1).   Statistical analysis: Data were recorded using Microsoft Excel 2013 software, and analyzed with SPSS v.22 (Chicago, IL, USA). Continuous data were summarized using means and standard deviations whilst categorical data were presented as proportions (%) by means of tables or figures. Student’s t-test was performed to assess differences between two means. Either Chi-square test with and without trend or Fischer’s exact test was used to test the degree of association of categorical variables. The factors associated with the recurrence of obstetric fistulas were obtained using logistic regression models. Unadjusted odds ratios (ORs) were initially calculated to screen for inclusion in multivariate models while multivariate ORs (95% CI) were computed after adjusting for confounding univariate factors with a p-value <0.05 considered as significant.

The mean age of the patients was 31.0 ± 7.4 years (range 20-34 years). The majority of patients came from areas located far than 60 km (61.3%) in average while 25.8% of women were residing in areas located at a distance ≤30 km. The majority of participants (48.4%) were multiparous. Labor duration exceeded 64 hours for 64.5% of women. The majority of fistulas (45.2%) were of type 1. followed by type IIBb(42%). About less than 64.5% of the patients had fistulas of less than 2 cm. The most common  location of fistula was trigonal (35.5%) followed by  pericervical (32%) .  Age ≥35 years (p = 0.012), FVV >2 Cm of dimension (p = 0.001), presence of vaginal septum (p = 0.007) and fibrosis (p = 0.008) were respectively 3.5-fold, 3-fold, 4-fold and 4.6-fold as likely to be associated with the recurrence of obstetric fistulas, leading to multiple surgical repairs. Other risk factors included labor duration >8h (p<0.01), hysterectomia (p = 0.007), and type III fistula (p = 0.004).

Recurrence of obstetric fistulas leading to multiple surgical repairs were found to occur in older women who developed type III fistulas, whose labor period was prolonged. Fibrosis developed post-surgery was also a major risk factor for subsequent surgical repairs. Hysterectomy was also seen to be frequently associated with fistulas with complicated initial repairs, hence leading to subsequent surgical procedures.

Labor duration should be monitored. Precautions must be taken to avoid complex fistulas and post-surgical development of fibrosis. Hysterectomy should be performed with caution to prevent the occurrence of fistulas during this surgical procedure.

Sjovelan S ET al. Surgical outcome of obstetric fistula : a retrospective analysis of 595 patients. Acta obstet GynecolScand. 2011 Jul; 90(7).753-60 doi: 10.1111/j.1600-0412.2011.01162. May 25.
Loposso et al. Predictors of recurrence and successful treatment following obstetric fistula surgery. Urology.2016 Nov; 97:  80-85 doi: 10.1016/J.Urology2016.03.079.EPUB 2016. Aug 2.