This study aims to assess the long-term safety and effectiveness of transvaginal repair for iatrogenic genitourinary fistulas, specifically evaluating fistula closure, complications, and quality of life (QOL) over 6 and 12 months of follow-up.

This prospective cohort study was conducted at LUMHS on 45 patients who underwent transvaginal repair for iatrogenic genitourinary fistulas. The primary outcomes were fistula closure and the incidence of complications, while the secondary outcome focused on quality of life (QOL) assessment using a standardized questionnaire. Recurrence was monitored over a 12-month follow-up period.

At 6 months, fistula closure was achieved in 92% of patients, with a recurrence rate of 4.4% (2 patients). The complication rate was 10%, including minor infections and delayed wound healing. QOL scores significantly improved, with 92% of patients reporting better sexual and urinary function. At 12 months, fistula closure remained at 90%, with no new recurrences and a continued improvement in patient-reported QOL.

A total of 45 patients added in the study. The mean age of patients was 37.4 ± 8.9 years, and all participants were female. The average fistula size was 2.4 ± 1.2 cm, and the majority of fistulas were associated with hysterectomy (48%). Most fistulas were located in the vesicovaginal fistula (68%), and the mean duration of the fistula before surgery was 6.2 ± 2.5 months.
At 6 months, 92% of patients achieved fistula closure, and this remained stable at 90% at 12 months. The recurrence rate was 4.4% at 6 months (in 2 patients) but was absent at 12 months. Post-surgical complications occurred in 10% of patients, primarily involving minor infections and delayed wound healing, but there were no major complications. Quality of life showed significant improvement, with 88% of patients reporting improved urinary function, 84% reporting improved sexual function, and 80% showing improved bowel function at 6 months, with further improvements at 12 months.
Minor infections occurred in 2 patients (4.4%), and another 2 patients (4.4%) experienced delayed wound healing. The remaining 91% of patients had no major complications, indicating that the procedure was generally safe with minimal adverse events.
At 6 months, 92% of patients had a successful closure of their fistulas, and 4.4% experienced recurrence. By 12 months, fistula closure remained at 90%, with no new cases of recurrence.
Urinary function had a mean score of 45 ± 15, with 75% of patients showing impairment. Sexual function had a mean of 40 ± 16, with 80% of patients affected. Bowel function scored 50 ± 12, affecting 60% of patients. Psychological well-being and general well-being had mean scores of 42 ± 14 and 47 ± 13, respectively, with 70% and 65% of patients reporting impairment. Social function showed a mean score of 49 ± 11, with 68% of patients experiencing some level of difficulty.

Transvaginal repair (TVR) is a safe and effective surgical option for the management of iatrogenic genitourinary fistulas (GUFs). The procedure achieved high fistula closure rates of 92% at 6 months and 90% at 12 months, with minimal recurrence (4.4% within 6 months) and low complication rates (10%), primarily involving minor infections and delayed wound healing. Additionally, significant improvements in quality of life were observed across urinary, sexual, and bowel function domains, with the majority of patients reporting substantial relief from preoperative symptoms

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