Prevention of residual urinary incontinence following successful repair of obstetric vesico-vaginal fistula using a fibro-muscular sling

Obstetric vesico-vaginal fistula remains a significant cause of female urinary incontinence worldwide. Approximately 2 million women suffer from this condition, perhaps many more, most of whom are in Africa. Very few centres are treating these patients, and although success rate in the closure of the fistula is high, up to 92%, this does not necessarily equate to a cure. A significant proportion of women remains with urinary incontinence. Little is known about the nature of this incontinence, and even less is known about how to manage it. This article describes a new and simple surgical procedure, which, when employed at the time of fistula closure, seems to reduce the incidence of residual incontinence in those women at a higher risk of developing it.