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Evaluation of surgical approaches for vesicovaginal fistulae repair: the case for transvaginal repair as the gold standard

Abstract

Introduction and hypothesis

To highlight the success rates of two approaches of transvaginal vs. transabdominal closures for the vesicovaginal fistula (VVF) repair and to investigate the patient, fistula, and surgical factors relevant to surgical characteristics and successful outcomes.

Methods

Retrospective analysis of 66 consecutive patients who underwent VVF repair between 2005 and 2020. Fistula profile, operative data, and postoperative outcomes were analyzed. Primary outcome was success rate with regard to surgical approach. Secondary outcomes were to compare patients’ and surgical characteristics with regard to surgical approach and correlate these characteristics relevant to surgical outcomes.

Results

A total of 66 women with a median age of 47 (27–82) years were included. Most (93.9%) of the VVFs were secondary to gynecological procedures. Thirteen (19.7%) patients had previous VVF repair. The median time from onset of leakage to surgical repair was 120 days. Forty-nine patients underwent transvaginal repair, whereas 17 (25.7%) women had abdominal repair. The success rates of transvaginal and abdominal techniques were 98% and 82%, respectively. Transvaginal approach had a significantly shorter operative time, less intraoperative blood loss, reduced hospital stay, and lower complication rates (p < 0.005). Age and time to surgery were positively and significantly correlated with surgical time [r (p value): 0.392 (0.003), (0.0386 (0.01)] and estimated blood loss [0.388 (0.002 and 0.410 (0.001)], respectively.

Conclusion

Transvaginal repair of VVF is a technically feasible and successful approach with significantly better operative parameters and lower complications. Despite varied etiology and different surgical approach, age and time to surgery are the main factors that correlate with operative time and blood loss.

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Authors

Contributions

Shamout S: Project development, Data Collection, Data analysis, Manuscript writing/editing. Anderson K: Management data analysis, Manuscript writing. Baverstock R: Management data analysis, Manuscript writing/editing. Carlson K: Project development, Data collection, Manuscript writing/editing.

Corresponding author

Correspondence to Samer Shamout.

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• None of the authors of this paper has a financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper.

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Shamout, S., Anderson, K., Baverstock, R. et al. Evaluation of surgical approaches for vesicovaginal fistulae repair: the case for transvaginal repair as the gold standard. Int Urogynecol J 32, 2429–2435 (2021). https://doi.org/10.1007/s00192-021-04869-w

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Keywords

  • Outcomes
  • Repair
  • Vesicovaginal fistula