{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T01:21:56Z","timestamp":1771550516089,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,1,27]],"date-time":"2017-01-27T00:00:00Z","timestamp":1485475200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000862","name":"Doris Duke Charitable Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006808","name":"University of North Carolina","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006808","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007880","name":"Johns Hopkins University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007880","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007890","name":"University of North Carolina at Chapel Hill","doi-asserted-by":"publisher","award":["5T32 HD075731\u201001"],"award-info":[{"award-number":["5T32 HD075731\u201001"]}],"id":[{"id":"10.13039\/100007890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Determine whether a 1\u2010hour pad test at discharge can identify continence status within 120\u00a0days of obstetric vesicovaginal fistula (<jats:styled-content style=\"fixed-case\">VVF<\/jats:styled-content>) repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Fistula Care Centre in Lilongwe, Malawi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with <jats:styled-content style=\"fixed-case\">VVF<\/jats:styled-content> who underwent repair between January 2012 and December 2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data on demographics, obstetric history, physical exam findings, operative management, postoperative findings, and follow up evaluations were collected on women with <jats:styled-content style=\"fixed-case\">VVF<\/jats:styled-content> repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Sensitivity, specificity, positive and negative predictive values (<jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">NPV<\/jats:styled-content>), and a receiver operating curve (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After <jats:styled-content style=\"fixed-case\">VVF<\/jats:styled-content> repair, 346 women had a 1\u2010hour pad test performed at the time of hospital discharge and completed follow up within 120\u00a0days of repair. Of these, 79.8% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0276) were completely continent, whereas 20.2% (<jats:italic>n<\/jats:italic>\u00a0=\u00a070) had some degree of\u00a0incontinence. The sensitivity and specificity of a negative 1\u2010hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5\u2010g threshold demonstrates a high predictive value (<jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>\u00a0=\u00a094.0%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 90.0\u201396.9) in detecting women with continence after repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At the 1.5\u2010g threshold, a negative pad test at discharge identifies 94% of women who will remain continent after <jats:styled-content style=\"fixed-case\">VVF<\/jats:styled-content> repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow up after repair is difficult.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>A negative pad test after repair is associated with continued continence at follow up.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14505","type":"journal-article","created":{"date-parts":[[2017,1,27]],"date-time":"2017-01-27T13:10:04Z","timestamp":1485522604000},"page":"966-972","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study"],"prefix":"10.1111","volume":"124","author":[{"given":"DM","family":"Kopp","sequence":"first","affiliation":[{"name":"UNC Project\u2010Malawi Lilongwe Malawi"},{"name":"UNC Department of Obstetrics &amp; 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