Surgeons’ perspectives for a future obstetric fistula classification system: exploring the key parameters

Abstract

There is currently no unified classification scheme for accurately describing vesico-vaginal fistulas, thereby limiting communication between surgeons and the ability to compare research. Many factors related to surgical failure or success have not been explored, and surgeons currently do not universally use the same classifications. The objective of this study is to determine which factors are the most important to include in a future obstetric fistula classification scheme. Members of the International Society of Obstetric Fistula Surgeons were surveyed using a non-validated questionnaire to explore their experience and factors they think were most important to include in an updated comprehensive obstetric fistula classification scheme. Based on the surgeons’ response, an average ranking of each determinant of obstetric fistula classification system was computed. The most critical factors that surgeons found necessary to include in an updated fistula classification system are the bladder size (88.9%, n=16, rank=8.53), degree of fibrosis of the vagina (83.3%, n=15, rank=8.12), degree of urethral damage (88.9%, n=16, rank=9.34), location of the fistula (100%, n=18, rank=9.22), urethral length (94.4%, n=17, rank=9.06), and whether the fistula is circumferential or not (94.4%, n=17, rank=9.18). The least important factors were how long the patient had had a fistula (11.1%, n=2, rank=2.28) and intraoperative complications (22.2%, n=4, rank=4.59). For most factors important in repair, there was a non-significant correlation between experience level and ratings from 0-10. Scores for urethral length showed a significant correlation between increased surgical experience and higher ratings of importance. Three most commonly used classification schemes by Goh, Waaldjik, and the World Health Organization (WHO) only capture some important factors determined by the surveyed surgeons. Given the inconsistency between what experienced and expert surgeons deem to be important determinants for the classification of obstetric fistula and what is currently included in classification systems, we call for constructing a new, validated classification system.