Functional outcomes and quality of life after vesicovaginal fistula repair: beyond anatomic closure.

PURPOSE OF REVIEW: Vesicovaginal fistula (VVF) repair has been historically measured by anatomical closure rates alone. This review summarizes recent evidence showing that successful treatment should also account for urinary continence, sexual function, psychological well-being, and social reintegration, highlighting a multidisciplinary approach to post-repair recovery.

RECENT FINDINGS: Although anatomic closure rates exceed 80-95% across surgical approaches, post-obstetric fistula repair incontinence affects 16-55% of women even after successful anatomic closure. International societies in urogynecology, obstetrics, and gynecology have recently proposed consensus definitions of surgical success that require continence restoration alongside fistula closure. Evidence demonstrates that sexual function generally improves after VVF repair; however, many continue to experience sexual dysfunction. These urinary and sexual functional outcomes also have significant psychosocial impacts, which vary by geographic and cultural context. Recent studies centered on patients with obstetric fistulas demonstrate that structured reintegration programs in sub-Saharan Africa have been found to significantly improve economic, psychological, and social outcomes.

SUMMARY: Contemporary evidence supports redefining successful VVF repair beyond anatomical closure. A comprehensive care framework emphasizes functional outcomes and quality of life, which is applicable across treatment settings but should also be tailored to the sociocultural context of the communities affected.