Transvaginal, transvesical, transabdominal, laparoscopic and robotic surgeries can be performed for vesicovaginal fistule (VVF) surgery. Transvaginal VVF repair is preferred primarily because it is the most minimally invasive surgical method. However, VVF in the location of vaginal cuff or supratrigonal location in the bladder, transvesical VVF repair may come to the fore due to difficulty in suturing. In our study, we aimed to present our single-center, long-term results of transvesical VVF repair, occurred after surgeries due to benign pathologies.

Forty-nine patients who underwent transvesical VVF repair between 2005-2020, whose data were available from our database, and had at least 6 months of follow-up, were retrospectively evaluated. The age of the patients, pathology caused VVF, comorbidity, fistule size, fistule location, and follow-up periods were recorded. It was noted how long after the transvesical VVF repair was performed after the first surgery, and whether any complications or recurrence occurred. As a surgical technique in transvesical repair; bladder was opened vertically, but incision wasn’t be extended to VVF tract. Transvesically, all sides of the VVF tract were freed, and 1-2 mm excised. The edges of the vagina were carefully removed from the bladder, and the vagina and bladder were closed respectively.

The mean age of the patients was calculated as 45.4 ± 10.3 (18-65) years. It was observed that hysterectomy performed for benign reasons in 41 (83.6%) patients, and cesarean in 8 (16.4%) patients played a role in the etiology of the patients. The mean fistula size was calculated as 17.6 ± 10.4 (3-50) mm. VVF was supratrigonal in 46 (93.8%) patients, and trigonal in 3 (6.2%) patients. VVF repair was performed in 2 (4.1%) patients within the first 2 weeks after the first surgery, and in 47 (95.9%) patients with a median of 4 (3-72) months after the first surgery. There were no peroperative complications in any of the patients, but 2 (4.1%) patients received blood transfusion in the postoperative period. In an average of 79.34±48.05 (8-172) months of follow-up, it was found that VVF was cured in 47 (95.9%) patients, and recurrence occurred in 2 (4.1%) patients. There was no statistically significant difference in terms of recurrence, and peroperative cystostomy placement (p=0.544). In the study, diabetes mellitus was found in 3 (6.12%) patients, and recurrence occurred in one (2.04%) of these patients. It was observed that both patients who had recurrence, accompanied a history of hysterectomy. There was no correlation between fistule size and recurrence (p=0.174).

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Transvesical VVF repair may be preferred primarily in VVF cases with a supratrigonal location in the bladder or vaginal cuff after surgery performed for benign reasons. High success rates, and very low recurrence rates, especially in a period of up to 15 years, support this preference.