Short-Term Success Rate and Risk Factors for Failure of the Urethral Plication Procedure in the Management of Post-Obstetric Fistula Closure Stress Urinary Incontinence Among Ugandan Women: A Prospective Cohort Study.

OBJECTIVE

To determine the six-month success rate and risk factors for failure of the urethral plication procedure in the management of post-obstetric fistula closure Stress Urinary Incontinence (SUI).

METHODS

This was a prospective cohort study of 70 women with moderate or severe SUI who underwent surgery for post-obstetric fistula closure SUI using the urethral plication procedure, managed at eight fistula repair sites in Uganda. Participants underwent clinical evaluation, methylene blue dye testing, post-void residual assessment, and single-channel cystometry to confirm stress urinary incontinence and exclude residual fistula, overflow incontinence, and urge incontinence. Urethral plication was the primary continence procedure; however, in some participants, concomitant reconstructive procedures, including urethral elongation and urethral reconstruction were performed based on intraoperative anatomical findings. The participants were followed up for a period of six months. Assessment for statistically significant changes in the grade of SUI at baseline and at six months post-surgery among the failures was done using Bowker's test of symmetry and the Stuart-Maxwell test for marginal homogeneity. Descriptive analyses and multivariable log binomial regression were performed to determine risk factors for failure.

RESULTS

A total of 70 women were enrolled with a mean age of 34 (SD ±12.1) years. Concomitant reconstructive procedures were performed in 26/70 (37%) of participants. The success rate at six months post-surgery was 61% (43/70) dropping from 70% (49/70) at time of discharge. Of the 27 participants who remained incontinent, 15 (56%) demonstrated improvement in the grade of incontinence (Bowker's test; χ2 = 20.0, df = 3, p = 0.0002, and Stuart-Maxwell test; χ2 = 17.9, df = 2, p = 0.0001). Severe vaginal scarring was the only independent risk factor (RR=3.77; 95% CI: 1.59-8.96; P=0.001).

CONCLUSION

The short-term success rate of the urethral plication procedure is moderately high, and in carefully selected women, it appears to be a safe and effective option for managing post-obstetric fistula closure stress urinary incontinence. Although the procedure is more likely to fail in women with severe vaginal scarring, the severity of the incontinence improves in those that fail.