FIGO expert opinion management of post-obstetric fistula repair incontinence for vesicovaginal fistula.

Abstract

Post-obstetric fistula repair incontinence (POFRI) is not unusual in fistula patients, and the diagnosis, as well as ongoing management of POFRI, can be challenging for surgeons, care teams, and patients alike. To address this issue and to start establishing consensus, FIGO (the International Federation of Gynecology & Obstetrics) held an Expert Fistula Surgical Workshop at the Addis Ababa Fistula Hospital in Ethiopia in early 2024. Recommendations, based on expert opinion from the gathering, including the use of standard terminology, history-taking, clinical examination, and investigations for further assessment such as residual urine volume, urinary diary, pad test, and urodynamics or single channel cystometry, are described in detail with the aim of giving concrete guidance. These will aid in the correct diagnosis of POFRI and tailor management to the patient's needs. In addition, the paper provides direction on how the different types of POFRI should be treated, including conservative and surgical options once diagnosed, with the accompanying flowchart serving as a practical visual overview. Women with pure stress urinary incontinence may be offered surgery, whereas women with pure overactive bladder symptoms should be treated conservatively. In women with mixed urinary incontinence, predominantly overactive bladder symptoms, careful consideration should be undertaken before performing surgery.