The current study in the DRC reports a FSROUVF rate approaching a quarter of all treated patients. We identified FSROUVF predictors as the presence of fibrosis, patient having 2 or more fistulas, total urethral damage, fistula size greater than 3cm, the use of intravaginal indigenous prod- ucts, and postoperative infection. Collectively, these factors constitute the HEAL Africa score which may allow surgeons to develop individualized treatment plans and implement appropriate strategies to minimize the risk of FSROUVF. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC, and in resource limited settings more generally. Improved surgical techniques and interdisciplinary approaches can also help improve surgical repair outcomes for OUVF, thereby improving the quality of life of patients with this debilitating condition.