Impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery

Objective Surgery is the only successful treatment for most obstetric fistulae. The present study measured the impact of a structured program of pre- and postoperative physiotherapy and health education on the outcome of surgery for obstetric fistula. Methods We compared the postoperative outcomes of 2 consecutive groups of women with obstetric fistulae who were recruited and followed-up by 2 local nongovernmental organizations at a hospital in Tanguiéta, Benin. The first group of women (n = 99) had fistula repair using standardized techniques. The second group (n = 112) had a standardized surgical approach plus a structured program of pre- and postoperative health education and physiotherapy. Results The program had a significant positive impact on recovery in general and on urinary incontinence in particular. After physiotherapy, the odds of recovery were 2.72 times greater for women in the physiotherapy group than for control patients, and the probability of postoperative stress incontinence was considerably higher for patients in the control group than for those in the physiotherapy group (P < 0.001). Conclusion A structured program of health education and physiotherapy by experienced nurses and physiotherapists improves the likelihood of a successful outcome after surgical repair of obstetric fistula. © 2013 International Federation of Gynecology and Obstetrics

One-year follow-up of women who participated in a physiotherapy and health education program before and after obstetric fistula surgery

Objective To investigate whether the positive impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery was maintained after 1 year. Methods The present follow-up analysis included 108 women who underwent obstetric fistula surgery at a center in Tanguiéta, Benin, between March 2011 and March 2012, and who had received a structured program of physiotherapy and health education before and after surgery. After discharge, follow-up visits were made 3, 6, and 12 months after surgery. The Ditrovie scale was used to measure quality of life (QoL), and continence and performance of the physiotherapy exercises were assessed. Results Mean QoL score was 36.9 (range 16.0-49.0) before surgery. Overall, 84 women were followed up for 1 year. Their mean QoL score had improved significantly to 18.5 (range 10.0-47.0; P &lt; 0.001). Between hospital discharge and 1 year, the number of women with a closed fistula increased from 48 (57.1%) to 53 (63.1%) and the number with urinary stress incontinence reduced from 11 (13.1%) to 9 (10.7%). Conclusion Results obtained after surgery and physiotherapy were maintained at 1 year, and QoL had improved significantly. When women are encouraged to continue exercises, improvements are also seen in residual stress incontinence