Surgical management and outcomes of vesicovaginal fistula: a 12-year experience in a tertiary center.

BACKGROUND AND

OBJECTIVES

Vesicovaginal fistula (VVF) is a devastating condition for female patients. We aimed to summarize our experience in the management of VVF and the surgical outcomes at our center and propose an algorithm for clinical practice.

MATERIALS AND

METHODS

We conducted a retrospective study of patients with VVF who underwent surgical treatment at our center between January 2013 and December 2024. All patients were classified into non-irradiated and irradiated groups. Medical data were analyzed, including patient demographics, fistula characteristics, vaginal width, surgical procedures, surgical outcomes, and perioperative complications.

RESULTS

We included 64 patients with VVF (20 non-irradiated and 44 irradiated). The fistula size in the irradiated group was mostly > 1.5 cm, whereas the size was <1.5 cm in the non-irradiated group. The vaginal width was > 3 cm in the fistula repair group, whereas it was < 3 cm in the urinary diversion group. For the non-irradiated group, we all performed fistula repair surgery, while only 47.7% in the irradiated group, where the remaining underwent urinary diversion (29.5%) or fistula repair + urinary diversion (22.7%). The irradiated group had a higher fistula recurrence rate than the non-irradiated group in both transvaginal (18.5% vs. 6.25%) and transabdominal (50% vs. 0%) approaches.

CONCLUSION

We proposed an algorithm for the surgical management of VVFs based on radiation history, fistula size (>3 cm), and vaginal width (<3 cm). We suggest that transvaginal approach is the first option for fistula repair. For irradiated VVFs, transvaginal fistula repair with tissue interposition combined with permanent cystostomy demonstrated high success in our series, which is a valuable method.