A NEW study from the Democratic Republic of the Congo has developed a promising tool to predict the likelihood of failed surgical closure of obstetric rectovaginal fistulas (RVF), a severe and life-altering complication often caused by traumatic childbirth. The study introduces the LUSSY score, a predictive model that could guide clinical decision-making and improve surgical outcomes for women facing this debilitating condition.
Researchers analysed data from 268 women with obstetric RVF who underwent surgery, finding that 12.3% of cases ended in failure to fully close the fistula. Using multivariate logistic regression, the team identified five key risk factors strongly associated with failed surgical closure: moderate to severe fibrosis, fistulas larger than 3 cm, combined fistulas involving other regions, intraoperative bleeding, and postoperative infection.
Each of these factors contributed to the creation of the LUSSY score, which ranges from 0 to 22. Patients scoring 13 or higher were found to have a high risk of surgical failure, while scores of 9 or below indicated a low-risk profile. The score demonstrated strong predictive performance, with an area under the ROC curve of 0.97, 91% sensitivity, and nearly 99% negative predictive value.
The study’s authors recommend that high-risk cases, particularly those involving complex or large fistulas, be referred for advanced surgical techniques beyond the transvaginal and transperineal approaches commonly used. They also emphasized the importance of preventing intraoperative haemorrhage and infection through better preparation, antibiotic prophylaxis, and careful postoperative monitoring.
This new tool could become instrumental in tailoring care strategies and improving outcomes for thousands of women suffering from obstetric RVFs in low-resource settings.
Aleksandra Zurowska, EMJ
Reference
Paluku JL et al. LUSSY score predictive of failure of surgical closure of obstetric rectovaginal fistula in the Democratic Republic of the Congo. Reprod Health. 2025;DOI: 10.1186/s12978-025-01971-w.
