Healthcare providers' perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo.

OBJECTIVE: To understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo. METHODS: In a qualitative study, semi-structured individual interviews were conducted with patient-care professionals working with women with fistula at HEAL Africa Hospital (Goma) and Panzi Hospital (Bukavu) between June and August 2011. The interviews were transcribed and themes elicited through manual coding. RESULTS: Overall, 41 interviews were conducted. Successful surgical repair was reported to be the most important factor contributing to patients' ability to lead a normal life by all providers. Family acceptance-especially from the husband-was deemed crucial for reintegration by 39 (95%) providers, and 29 (71%) believed this acceptance was more important than the ability to work. Forty (98%) providers felt that, on the basis of African values, future childbearing was key for family acceptance. Because of poor access and the high cost of cesarean deliveries, 28 (68%) providers were concerned about fistula recurrence. CONCLUSION: Providers view postsurgical childbearing as crucial for social reintegration after fistula repair. However, cesarean deliveries are costly and often inaccessible. More work is needed to improve reproductive health access for women after fistula repair.

Use of periurethral injections of polyacrylamide hydrogel for treating post-vesicovaginal fistula closure urinary stress incontinence.

AIMS: Following successful closure of obstetric genitourinary fistula, stress urinary incontinence (SUI) is a common and challenging problem. Despite many decades of various treatment options, the effective management of post-fistula SUI remains unresolved. This study aims to assess the feasibility of periurethral injections of polyacrylamide hydrogel, commonly used for urinary stress incontinence in non-fistula women, in women with post-fistula closure SUI. MATERIAL AND METHODS: Women with urinary incontinence following successful fistula closure were assessed to exclude detrusor overactivity and urinary residual volumes of more than 100 mL. The urethrovesical junction was identified and polyacrylamide hydrogel was injected through the periurethral skin and vaginal epithelium at three sites. RESULTS: Four women with post-fistula SUI were treated with polyacrylamide hydrogel injections. Three of the four women were dry post-operatively and remained continent at discharge. CONCLUSION: In the short-term, periurethral injections of polyacrylamide hydrogel appears to be a promising method to treat post-obstetric fistula urinary stress incontinence.