[Vaginal route treatment for residual urinary incontinence after closing an obstetrical fistula: apropos of 49 cases].

Objective: Described here is a simple treatment for female urinary incontinence present and concurrent cystocele repair, if present. The objective of this technique which combines a bladder neck and a suprapubic percutaneous suspension, is to obtain by a sling effect, efficient cure of the urinary incontinence, in avoiding the common retention problem.
Patients and Methods: Between 1992 and 1998, 49 black female patients were treated with this procedure. Average age was 18 years old (the youngest 14, eldest 29 years old) 39 were primigravid while 10 were multigravid (2 to 6 childbirths). 12 (24. 4%) have undergone at least 2 operations for fistula cure, 6 of the patients showed previous incontinence surgery; Burch technique (n=1), Martius fat sling (n=3) and anterior colporraphy (n=2). 25 patients (51%) were suffering from a severe incontinence, for 17 cases the urine leak was grade 2 and 8 cases grade 3 at decubitus.
Results: No bladder lesion occurred on any of the 49 patients. Except for one general peritonitis which occurred on a patient who was receiving a combined recto-vaginal fistula operation, the post operative complications were minor (n =7). We observed only one direct recurrent urinary incontinence which was treated a second time with the same technique and was cured. For 46 studied cases and an average follow-up of 28.6 months, 29 patients (63%) were declared totally cured, 8 (17.3%) showed functional improvement, 9 (19.5%) remained incontinent. The global success rate (cure and improvement) was obtained in 80% of cases. The results were less satisfactory in multi-operated patients, particularly in those who suffered from extensive cervico urethral damage (Group III). In this group only one out of two patients obtained cure or improvement.
Conclusion: Due to its real simplicity the bladder neck and vagina wall sling is easy to redo, and because its reliability we have chosen this procedure as a choice treatment for incontinence following a vesico vaginal fistula. The excellent results confirmed by a longer follow-up has led us to extend its indication to all types of female urinary incontinence. This technique is particularly well suited for use in developing countries.