Title: Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair
in southern Ethiopia
Version: 1 Date: 23 Nov 2023
Reviewer's report:
Review Feedback
I would like to thank the authors for doing research on the topic which is interesting.
However, the following comments need to be addressed to improve the manuscript.
Abstract: Needs revision.
Introduction: is wide and has not focused on the title. Lots of information about fistula than
factors of post-fistula repair UI.
Needs to be revised and focused
Method:
Under exclusion criteria: the reason for excluding patients with double fistula repair was not
clear. The presence of Concomitant RVF usually shows the severity of injury and definitely be
one of the determining factors of failure and UI.
Result:
• Sociodemographic- instead of describing weight and height, it would have been better to
calculate BMI to assess their nutritional status. I thought it was supposed for this purpose.
• Table 1: how is possible to get information like age at first pregnancy and education for all
patients? This doesn’t seem to be possible from chart and logbook review. The age classification
has to be corrected too as age <18 and >=18.
• Table to needs to be merged with Table one
• Table 3 ANC- # and % are misplaced.
• Fistula characteristics of patients-… nearly one fourth 96(19.2%) …19.2% is not 1/4th
• Table 5- presence of infection-the # and % for Yes/No are misplaced.
Discussion
• The discussions are not plausible as there are no logical explanations of the similarities and
differences of the key findings. The explanation made for all was similar and unfound.
• For e.g. for … In this study, the magnitude of UI after successful closure of obstetric VVF
repair was in line with Pakistan (24.5%)[12], Malawi (24%) [24], Ethiopia (Bahir Dar Hamlin
fistula center) 24.8% [27]. The consistencies might be due to similar characteristics of patients,
inclusion criteria, and similar causes of VVF in low- and middle-income countries that are
obstructed labor due to the unavailability of quality obstetric care to reproductive-age women…
the explanation is not clear
o Is it anticipation or you have checked their data? Which characteristics were similar?
o The patient characteristics like Goh classifications, causes, surgeons’ experience, nutritional
status of patients, etc. are important variables to compare with.
• Third paragraph
Compare with some characteristics, otherwise, the discussion will not be plausible.
o Fistulas arising from CS if it is not from OL is not the cause of UI. Because the fistulas are
juxta cervical or mid-vaginal and will not involve the urethra.
o What does a large sample size mean? A representative sample is needed for research and there
is no called sample size.
• 5th paragraph- lacks a scientific explanation of the findings. This would have been avoided by
including the expert fistula surgeon or gynecologist working on repair from the center (content
expert).
• Strength and limitations
• The statement stating ….The second strength of the study was the wide assessments of patient
characteristics from the source of medical charts and operation logbook, which was not possible
to collect all these variables from the individual data… This is the research itself not a strength.
Conclusions
The statement which states….Therefore, there is a need to formulate strategies or solutions to
mitigate the problem specifically for those patients at high risk of having UI after the successful
closure of obstetric VVF repair.... is not. And then what? This has to serve for designing access
to expert managing post-fistula repair UI or may help to select which patients will be managed
by beginners.
General comment: the grammar and flow of the concepts have to be double-checked as there
are several errors that I didn’t comment on.