Surgical repairs of vesicovaginal fistula (VVF) are most commonly performed vaginally, abdominally, or laparoscopically. The transvaginal method of VVF repair is generally preferred due to its minimally invasive nature and reduced morbidity. Surgical approach is often dictated by complexity of the fistula and surgeons’ preference. This study aims to present the outcomes of all patients referred with vesicovaginal fistulae to a tertiary centre, and to investigate the patient, fistula, and surgical factors relevant to success.

We retrospectively reviewed the database registry of 63 consecutive patients who underwent vesicovaginal fistula repair at a tertiary care centre between January 2005 and November 2019. Participant information was obtained including clinical evaluation, demographics, fistula profile, and surgical approach (transvaginal or transabdominal). Operative data, postoperative outcome, and follow-up information was analyzed. Patients were categorized by surgical approach and comparative statistical analysis was done.

A total of 63 women with a mean age of 47.7 (±10.7) years were included in the study. Forty-two patients had transvaginal repair, whereas 21 VVF had abdominal repair. Mean body mass index was 28.8 kg/m2 (±7.27). The aetiology of fistula was secondary to malignancies in 6 (9.5%) patients and gynaecological/obstetric procedure related in 57 (90.4%) patients. Thirteen (20.6%) patients had prior repair and 50 (79.3%) were naïve. The mean period from onset of leakage to time of surgical repair was 44.47 (±85.1) days. Transvaginal approach had a significant shorter operative time, less intraoperative blood loss and reduced postoperative hospital stay (P<0.005). Transabdominal repair was associated with increased complications after surgery (P<0.05) (Table 1). Length of operative time and estimated blood loss were positively and significantly correlated with age (r (p value): 0.392 (0.005), 0.394 (0.002) and time to surgery (0.0386 (0.01) and 0.416 (0.002)), respectively.  The success rate of transvaginal and abdominal techniques were 97.6% and 85.7% respectively.

The successful management of VVF hang in the balance of numerous factors, including fistula etiology, the complexity and characteristics of the fistula itself, and surgical expertise. With lack of standardized surgical approach; transvaginal repair remains one of the most established surgical options for VVF including recurrent and complex cases. In this framework, comparative advantage is determined by the minimally invasive nature and reduced peri- and postoperative morbidity. Our results confirm these considerations true: Success rate, defined as absence of urinary leakage following catheter removal was 97.6% with transvaginal (TV) vs 85.7% for transabdominal repair (TA). With nearly a quarter of patients in the TV group had a previous fistula repair, only one patient had failed fistula closure which is likely attributed to previous pelvic radiation and complex repair.  Furthermore, the minimally invasive nature of TV approach is corroborated since intra- and postoperative parameters (surgical time, blood loss, and hospital stay) were significantly in favour of TV group.

Transvaginal repair of VVF is a technically feasible approach with a high success rate and low morbidity. Despite varied aetiology, and different surgical approach, patient age and time of VVF repair are significant determinants of operative complexity.