Historically, the majority of vesicovaginal fistulas (VVF) in developing countries were due to obstetric causes. However, with advances in obstetric care coupled with increased gynecological pelvic surgeries, the epidemiology has shifted towards iatrogenic VVF. We aimed to determine the disease characteristics, treatments and complications of VVF repair in the contemporary era and sought to compare obstetric and iatrogenic causes of VVF in this respect.

A retrospective analysis of data undergoing VVF repair between April 2011 and April 2024 was conducted from the hospital base and analyzed. The patients were divided into 2 groups: those undergoing VVF repair for obstetric causes (obstructed/ prolonged labor - group 1) and for iatrogenic causes (hysterectomy/LSCS - group 2). The disease characteristics, treatments and complications were compared between the 2 groups. Patients with missing data were excluded.

118 patients were included; 24 (20.3%) in group 1 and 94 (79.6%) in group 2. In the overall cohort, the mean age was 37.1 years. The mean size of fistula was 13.9 mm and majority (66.1%) were primary repairs. 71.1% of patients underwent transvaginal repair.  3 patients had concomitant ureterovaginal fistula. Patients with obstetric cause of fistula were found to be significantly younger (34.4 vs 37.9 yrs, P value = 0.04), having longer duration of fistula before presentation (36.5 vs 24.3 months, P value = 0.009) and less likely to have undergone previous repairs (0.5 vs 1, P value = 0.03). There was no significant difference in outcome of repair, complications and postoperative urinary dysfunction (SUI/ UUI) between the 2 groups.

71.1 % fistulas are repaired vaginally. Obstetric and iatrogenic fistulas are similar with respect to perioperative and postoperative outcomes.

• Post hysterectomy/post LSCS fistulas appear to be increasing
• There is High initial success rates in both obstetric and iatrogenic fistulas.
• 71.1 % fistulas are repaired vaginally.
• There is an importance of specialist tertiary care centre especially for re-operative cases.
• Obstetric and iatrogenic fistulas appear similar with respect to perioperative and postoperative outcomes.