Beyond Continence: Long-Term Psychosocial Adaptation Following Mainz II Urinary Diversion for Incurable Obstetric Fistula in Rural Uganda.

Background: Obstetric fistula remains a debilitating maternal health condition, particularly in low-income countries. The Mainz II pouch, a continent urinary diversion, is a last-resort surgical option for irreparable fistulas. Despite surgical success, little is known about long-term psychosocial outcomes in such settings. This study aimed to explore the long-term lived experiences and quality of life outcomes of women in rural Uganda who underwent the Mainz II pouch procedure for incurable obstetric fistula, with a focus on post-surgical equity and adaptation. Methods: This qualitative study, informed by biopsychosocial and feminist political economy frameworks, utilized in-depth interviews guided by a culturally adapted World Health Organization Quality of Life (WHOQOL-BREF) tool. Six women with obstetric fistula and one with a non-obstetric urological condition were purposively sampled and interviewed 5-14 years post-surgery. Thematic analysis using NVivo 12 followed a rigorous six-phase approach, with intercoder reliability (κ=0.82) ensuring analytical rigor. Results: Participants reported restored continence and improved physical functionality. However, ongoing nocturnal incontinence, psychological distress, and social stigma persisted. Younger women (23-33 years) adapted better compared to older counterparts (52-70 years), who faced challenges such as social isolation. Conclusion: Mainz II pouch surgery offers physical relief but insufficient psychosocial recovery. To address systemic inequities in post-fistula care, health systems in low-income countries must prioritize integrated, context-sensitive rehabilitation services that include mental health, sexual health, and long-term follow-up.