Vesiscovaginal fistula (VVF) remains a devastating event for patients which carries a significant emotional burden.  Whilst a trial of conservative management may be considered, surgical management is often necessary. The majority of surgeons either preference a vaginal or abdominal approach. Traditionally urologists have repaired vesicovaginal fistula (VVF) abdominally and gynaecologists vaginally.  We have reviewed the routes of repair in a 2 surgeon series of VVF managed at a tertiary referral centre between 2000 and 2017 to ascertain the trend in route of repair and whether the route of repair is related to the outcome of surgery

Since 2000 a prospective database for all patients with VVF has been kept which details all patients diagnosed with a diagnosis  of VVF. Included on the database was patient demographics, fistula aetiology, route of repair and final outcome was recorded for each consecutive 5 year period.

139 patients of median age 50 years (range 21-88) were referred with VVF during this period. In total 155 VVF repairs were performed in these women: 62 via the  abdominal route and 93 via the vaginal route. The absolute indications for initially attempting an abdominal repair was considered to be a concomitant requirement for simultaneous ureteric reimplantation and/or clam cystoplasty, or early repair following abdominal procedure. 9 patients met the criteria mandating an abdominal repair; the remainder 53 patients had an abdominal repair due to surgeon preference.  Absolute indications for abdominal repair were present in 9 women; the remaining 53 women had an abdominal repair due to surgeon preference or difficulty accessing the fistula vaginally. The details of route of VVF repair, time period and outcomes are shown in Figures 1.and 2

There was no significant difference between abdominal or vaginal closure ( p> 0.05) and anatomical closure was achieved in 97% patients overall. There is a trend towards increasing number of vaginal repairs without compromising the outcome.

Vaginal repair of VVF has become increasingly common in urologists hands with excellent fistula outcomes. VVF potentially offers patient reduced morbidity as there is no abdominal incision and therefore a quicker recovery. Hence, it  should be the route of choice if there are no absolute indications for abdominal repair