Vesicovaginal fistula (VVF) is a debilitating condition associated with continuous urinary leakage and significant impairment in quality of life (1),(2). Surgical repair aims to achieve a tension-free and watertight closure; however, the optimal surgical approach remains debated (3). This study aimed to compare outcomes between transabdominal and transvaginal repair and to identify factors associated with successful fistula closure.

A retrospective analysis was conducted over a 10-year period (January 2015–November 2025), including 68 women undergoing surgical repair for VVF. Patients managed by urinary diversion were excluded.
Patients were stratified according to the initial surgical approach: transabdominal (group A, n=53) and transvaginal (group B, n=15). Clinical variables included etiology, history of hysterectomy, irradiation, recurrent urinary tract infection, prior catheterization and fistula duration. Fistula characteristics (size, number, location) were assessed cystoscopically.
Surgical variables included the operative approach, use of interposition flaps and type of urinary drainage. The primary outcome was successful closure following primary repair. Statistical analysis was performed to compare outcomes and explore predictors of success (p<0.05).

Previous hysterectomy was the most common etiology in both groups. The primary closure rate was significantly higher in the transabdominal group compared to the transvaginal group (96.2% vs 66.7%, p=0.005), consistent with previously reported outcomes (2),(3). Surgical approach was the only factor associated with successful fistula closure.

Recurrent urinary tract infection was more frequent in the transvaginal group (40% vs 16.4%, p=0.042). Complex fistulas were more frequently managed via the transabdominal route, although this difference did not reach statistical significance (p=0.2). Median fistula duration prior to surgery was comparable between groups (2 vs 3 months, p=0.171) and did not influence outcomes.

Hospital stay was longer following transabdominal repair (16 ± 4 days) compared to the transvaginal approach (5 ± 2 days).

Both transabdominal and transvaginal techniques are effective for VVF repair. In this cohort, the transabdominal approach was associated with a higher likelihood of primary closure, despite being used in patients with more complex disease. The transvaginal approach was associated with shorter hospitalization and may be appropriate in selected cases.

These findings support the role of surgical approach as a key determinant of outcome, alongside fistula characteristics and surgical expertise (3). However, the retrospective design, relatively small sample size and unequal group distribution may introduce selection bias. In addition, the long inclusion period, potential evolution of surgical techniques and surgeon preference in selecting the operative approach may have influenced the observed outcomes.

Both approaches represent valid options for vesicovaginal fistula repair. In this study, the transabdominal approach was associated with higher primary closure rates, while the transvaginal approach was associated with shorter hospitalization. Individualized selection of surgical approach remains essential to optimize outcomes.

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