Classification of female genito-urinary tract fistula: Inter- and intra-observer correlations

Abstract

Background: Currently, there is no accepted standardized classification for genital tract fistulae. Many classifications have been proposed previously, mainly based on anatomical locations. This is the first paper on inter- and intra-observer correlations using a recently published classification system based on fixed reference points. Aim: To assess intra- and inter-observer reliability of a new classification for genito-urinary fistula. Methods: This is a prospective assessment of women with genito-urinary fistula. Women attending the Fistula Clinic in Ethiopia and Liberia were assessed by three fistula surgeons. The women were assessed in the outpatients and the fistulae were staged. In Liberia, where two surgeons were working together, inter-observer reliability was assessed. All women had the fistulae restaged in the operating theatre and intra-observer concordance was assessed. The clinicians were blinded to the outpatient results. Results: A total of 119 women were recruited. All women had intra-observer assessment and had the fistula examined by the same clinician in the outpatients and in the operating theatre. Fifty of these women had inter-observer assessment with two clinicians assessing the same women. The results demonstrated that this classification system had high concordance in intra- and inter-observer reproducibility. Conclusion: The new classification for genito-urinary fistulae utilizing fixed reference points is a useful tool in describing fistulae. This study has shown that this classification produced consistency in description amongst different clinicians and also by the same clinician in a different consultation. This therefore allows more precise communication of clinical findings.