There is dearth of literature on the predictors of risk factors for long-term residual urinary incontinence and its relation to quality of life. As a referral centre for complex cases, we have seen a growing number of patients with urogenital fistula who have had prior attempts at repair and primary complex cases also. 
Here, in this study we will describe the urogenital fistula characteristics, surgical approaches, outcomes for cases, factors predicting success and parameter predicting risk of residual urinary incontinence and its impact on quality of life.

Primary Objective: 
1)To describe etiology, repair techniques and outcomes for primary and recurrent urogenital fistula.
Secondary objective: 
1)	To assess predictors of residual urinary incontinence
2)	To note complication rates in primary and recurrent urogenital fistula
3)	To determine significance of Goh classification in deciding surgical approach and predicting outcomes.

Type of study: A prospective observational study 

This study was conducted after ethical clearance obtained. 

All women who had undergone urogenital fistula repair by either a transvaginal or abdominal approach or combined approach or laparoscopic or robotic approach, with a minimum follow-up of 3 months are included in the final analysis. Taking into consideration the inclusion and exclusion criteria the study subjects were selected. 
The patients is explained about the entire procedure and written informed consent taken. All of them were interviewed and detailed history was obtained. Pre-, intra- and post-operative details were obtained. The interim follow-up details were recorded from the outpatient cards of each patient
The participants were asked to fill the validated UDI-6 questionnaire (UROGENITAL DISTRESS INVENTORY, SHORT FORM) at 3 month follow up. The questionnaire assesses filling, voiding and incontinence symptoms. Participants were asked about their experience of 6 specific symptoms.
The score varies from 0 to 100.The basic interpretation of the score is, higher the score, the higher the disability. For UDI-6 scores more than 33.33 indicate higher distress caused by UI.

41 series of patients were enrolled, of which 21 were complex cases ( repeat cases, radiation induced, ureteric involvement, urethral involvement). 14 cases had previous attempt to surgery. Median age of patient was 37 years. Median time of occurrence of fistula to repair was 3 year 8 months. Total abdominal hysterectomy contributed to 78% of causes. Total laparoscopic hysterectomy, radiation induced, post vaginal delivery and Caesarean section contributed to 4.8% of cases. Other pelvic reconstruction surgery adds to 2.4 % of cases. 80.48 %( 33 cases) were done by transvaginal approach, 7 by abdominal route and 1 by robotic approach. 24.39 % of cases required tissue transposition, Martius labial flap used in 6 cases and omental graft in 4 cases.
At 3 month follow up, UDI questionnaire was asked. To assess quality of life at 3 month UDI score was calculated, it was found after surgical fistula repair many patients were having complain of pain during urination, increased frequency and urgency of six questions asked. 4 patients at 3 month follow up have UDI score > 33.33, indicating high distress caused by urinary incontinence.

Despite a high rate of recurrent and complex Urogenital fistula, successful lasting closure was achieved in 95.12% of our cases. A minority of patients developed urinary problems, suggested by high UDI score that may require further treatment. It is important to remember that many iatrogenic bladder injuries are recognized intraoperatively and a urologist can be called to the operating theatre
and asked to repair a bladder injury vaginally or abdominally. Indeed, prevention of a fistula by good repair of an intraoperative injury is better than cure. Use of tissue transposition has a very important role in healing of fistula.

Although the best chance of repair is at the first attempt, we found a high success rate for complex cases. Individualizing  the surgical approach according to the fistula and the patient characteristics has yielded excellent outcomes. Majority of cases underwent transvaginal repair. Even patients with a complex fistula and those who have had multiple attempts at
repair can experience a cure. Residual risk factors for prediction of urinary incontinence at follow up, needs to be further explored. Surgical cure does not predict the outcome for residual urinary incontinence. Quality of life is an important aspect for determination of success of surgical repair.

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