Vesicovaginal Fistula Research Articles

A0633 - The management and outcomes of vesicovaginal fistula

A0633 - The management and outcomes of vesicovaginal fistula

A0977 - Effectiveness of local interstitial application of Platelet-Rich Plasma in the complex treatment of vesico-vaginal fistulas

A0977 - Effectiveness of local interstitial application of Platelet-Rich Plasma in the complex treatment of vesico-vaginal fistulas

Transvaginal Approach for Repair of Vesico Vaginal Fistula: An Effective Approach

To describe that the transvaginal approach is an excellent route for the repair of vesico vaginal fistula without compromising on success rate. Material and Method: It is a reterospective analysis of 64 cases operated in 10 years. All were operated through transvaginal approach. Study included all supratrigonal, trigonal and infratrigonal fistulas as classified on cystoscopic findings bases. Results: Sixty four patients with vesico vaginal fistula were included in the study. The age of patients was from 20 to 58 years with a mean age of 44.6 years. According to age these were divided into four groups. The cause of vesico vaginal fistula was abdominal hystrectomy in 57 (89.06%) patients while obstructive labour in 7 (10.96%) patients. The size of fistula was further categorized in three groups. The success rate was 87.5% (56 patients) in first attempt while the fistula of remaining 8 patients (12.5%) was successfully repaired in second attempt. Supra trigonal fistula was present in 54 (84.38%) patients while 10 (15.62%) patients had trigonal or infra trigonal fistula. Conclusion: By comparing different approaches, the vaginal approach had a comparable success rate with less morbidity. We suggest, for repair of vesico vaginal fistula, the transvaginal approach should be a preferred approach for a vaginally accessible fistula over tranabdominal approach.

Epidemiology and care pathway of vesicovaginal fistulas managed in France between 2010 and 2018.

To evaluate the incidence of vesicovaginal fistula (VVF) in France. We conducted a retrospective analysis of prospectively and systematically collected data from January 2010 to December 2018 in the French Hospital Discharge Database. We used ICD-10 code "N820" to identify new VVF diagnoses. VVF incidence was calculated using estimations of the French population. We compared age on diagnosis, medical history of pelvic tumoral disease, radiotherapy, hysterectomy and childbirth, according to three subgroups: surgical repair attempt (SRA), long-term catheter and/or nephrostomies (LTC) or immediate surgical urinary diversion (ISUD). We focused on the patients diagnosed in 2017 to better analyse VVF aetiologies and outcomes (7-year hindsight and 1 year of follow-up). Chi-squared and Kruskal-Wallis tests were, respectively, used for qualitative and quantitative data comparisons. Of the 196 million hospital stays out of 50 million French citizens hospitalised from 2010 to 2018, 5499 women were hospitalised for VVF. The estimated incidence of VVF was 2.3/100,000 women-year. Approximately half of the patients underwent SRA (48.4%); 39.8% had LTC and 11.9% had ISUD. Patients were younger in the SRA subgroup (53.4 ± 14.7years p < 0.001) with a lower rate of pelvic cancer (p < 0.001) or radiotherapy (p < 0.001) and a higher rate of hysterectomies (p > 0.001). In 2017, two-thirds of the VVF diagnosed were secondary to pelvic surgery. Mean management time was 9.2 ± 10.6months. After SRA, 5.4% underwent incontinence surgery and 5.0% underwent secondary surgical urinary diversion. VVF is not a rare pathology in France, mainly due to pelvic surgery. Its management is complex and not well defined.

UROVAGINAL FISTULA IN TERTIARY HOSPITAL OF WEST JAVA INDONESIA

Objective: This study was conducted to find out the frequency and characteristics of urovaginal fistula patients. Material &amp; Methods: This study design used a retrospective descriptive research design conducted at a tertiary hospital in West Java, Indonesia (Hasan Sadikin General Hospital) from 1 January 2010 to 31 December 2016. Results: Of all 22 urovaginal fistula patients, the majority in the age range of 41-50 years, and there was one patient in the age range of 61-70 years. Fourteen patients (63.6%) had defects in the bladder, and 36.5% of patients had defects in the ureters. There were nine patients (40.9%) who had urovaginal fistula after undergoing a hysterectomy procedure. The other causes were cervical carcinoma (40.9%), difficult labor (9.1%), radiotherapy (4.5%), carcinoma rectum (4.5%), cesarean section procedure (9.1%), and other gynecological procedures such as myomectomy or cystectomy (9.1%). Based on the type and location of the fistula, the majority of patients had vesicovaginal fistula/VVF (59%), ureterovaginal fistula/UVF (36%), and a combination of ureterovesicovaginal fistula (5%). The causes of VVF and UVF are different from each other. In patients with VVF, the most common cause is cervical carcinoma (35.7%). Meanwhile, the most common cause of UVF is hysterectomy (75%). Conclusion: Of the various types of urovaginal fistulas, vesicovaginal fistulas are the most frequently encountered. In general, the characteristics of urovaginal fistula patients in Hasan Sadikin General Hospital is slightly different from the literature, especially the cause of fistula. At Hasan Sadikin General Hospital, vesicovaginal fistulas are mostly caused by cervical cancer, not a hysterectomy. For ureterovaginal etiology, the characteristics of patients in Hasan Sadikin General Hospital are caused mainly by hysterectomy.

The Manchester operation – is it time for it to return to our surgical armamentarium in the twenty-first century?

We conducted a study to assess the efficacy and outcome results of Manchester operation for women with symptomatic elongation of uterine cervix between 2010 and 2020. Forty-five women were enrolled. Mean age was 54.2 ± 10.5 years, 57.5% were premenopausal. Mean follow up was 4.53 years. Most patients were pleased from the surgery: 29 (76.3%) very pleased and three (7.9%) quite pleased. There were four cases of late postoperative complications: hematometra, pyometra, vesicovaginal fistula and small bowel evisceration through the posterior vaginal fornix. All four cases required surgical interventions with complete recovery. Manchester operation is an effective procedure for symptomatic elongation of uterine cervix. The surgery is short, minimal blood loss and without significant intraoperative complications. However, it is not free of late postoperative complications and it is therefore important that the surgery will be carried out with a strict technique and by skilled surgeons who are capable to manage unique postoperative complications. Impact Statement What is already known on th is subject? Elongation of the uterine cervix is a condition that has not been sufficiently studied. Up-to-date data regarding the efficacy and safety of the Manchester operation for patients with cervical elongation and normal pelvic support are scarce, as most previously published studies included mainly patients with uterine prolapse. What do the results of this study add? The present study presents the efficacy, complications and clinical outcomes of Manchester operation for women with elongation of the uterine cervix. Our results show that Manchester operation is safe, effective method for symptomatic uterine cervix elongation. What are the implications of these findings for clinical practice and/or further research? This suggests Manchester operation is an effective procedure for symptomatic uterine cervix elongation should be implemented more widely. It must be carried out with a strict technique by skilled surgeons capable to manage unique postoperative complications.

Robot Assisted Laparoscopic Repair of Vesicovaginal Fistula: A Retrospective Study at a Tertiary Care Centre, Chennai, India

Introduction: Vesicovaginal Fistula (VVF) is the most common acquired fistula of the urinary tract in women. Robotic surgery is recently introduced for VVF repair and has benefits over conventional methods. Aim: To describe experience with robot-assisted laparoscopic repair of VVF in patients. Materials and Methods: This was a retrospective observational study conducted from February 2014 to February 2018, at Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India. The study included 24 patients who underwent robot-assisted laparoscopic VVF repair. After cystoscopy ureteric catheter was passed through the fistula and retrieved through vagina. Bilateral ureteric catheters were placed simultaneously with vaginal packing. Da Vinci Si robot was docked with patient in trendelenburg position. After trocar placement transperitoneally the fistula was approached. Through vertical or transverse cystotomy, fistula was identified. With the circumferential incision around the fistula, both the bladder and vagina was separated and the fistulous tract was excised. Bladder was closed vertically and vaginal opening was closed transversely interposing the Omentum. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 40.33 years. Elective hysterectomy done for benign conditions (91.67%) was the major cause of VVF in patients followed by emergency hysterectomy (8.33%). All of the patients underwent adhesiolysis while two patients performed right ureteric re-implantation additionally. The median operative time was 127.50 minutes. The median duration of drain and hospital stay was three days each. Urethral Foley’s catheter removal done at 2-3 weeks based on operating surgeon’s preference and the mean duration of follow-up was 26 months. Conclusion: Robot-assisted laparoscopic VVF repair is convenient and an effective approach in the successful management of VVF in complex fistulas and recurrent cases.

Obstetric Fistula Repair Through Transvaginal Approach: The Experience in DMCH

Background: Vesicovaginal fistula (VVF) is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. The successful closure depends on many factors, although the majority of genitourinary fistulas can be closed surgically. Aim of the study: The aim of the study was to find out the outcome of obstetric fistula repair through a transvaginal approach. Methods: This prospective observational study was conducted in the Department of Gynecology & Obstetrics, Dhaka Medical College Hospital Dhaka, Bangladesh from June 2006 to May 2007. A total of 30 women with VVF difficulties who were admitted to the hospital were recruited as the study population. To repair the obstetrics fistula of women, the transvaginal surgical procedure was followed. For data analysis, statistical software SPSS version 22.0. All data were presented in mean values. The results were presented in tables, figures. The observations were recorded as statistically significant (p-value <0.05). Results: Postoperative complications were not found in 28 (93.3%) cases and no information was found in 2 (6.7%). Duration of retaining catheter (days) <10 in 1 (3.3%), 10-15 in 19 (63.3%), 16-21 in 8 (26.7%) and no information found in 2 (6.7%). Total length of stay (week) was 3-4 week in 13 (43.3%), 5-8 week in 10 (33.3%), 9-12 in 3 (10.0%), 13-24 in 4 (13.4%). The patient developed stress incontinence in 8 (26.7%) and no information was found in 22 (73.3%). 20 (66.7%) cases resulted successfully, Stress incontinence was found in 3 (10.0%), failed VVF in 1 (3.3%), Failed RVF in 6 (20.0%). The reason for failure was 2 (6.7%) bad cases and no information was found in 28 (93.3%). Conclusion: The transvaginal approach is less invasive and achieves comparable success rates as compared to other methods of VVF repair. Genital fistula repair surgery with Foley catheter has a high success rate, reduced morbidity, minimal blood loss, and short tome hospital stay.

Vesico-Vaginal and Recto-Vaginal Fistula and Death Caused by a Vaginal Foreign Body in a Body-Packer

Foreign body retained for long duration sometimes causes vesico-vaginal and recto-vaginal fistula. We report a 60-year-old woman with vaginal foreign body causing vesico-vaginal and recto-vaginal fistula; she died after foreign body removal due to septic shock. The patient had vaginal purulent discharge, abdominal pain, and a septic shock. A fragment of stone (limestone) was present in the vagina, which was removed. The patient developed urinary incontinence and fecal incontinence after removal of the foreign body. The examination demonstrated the presence of vesico-vaginal and recto-vaginal fistula. The patient died four days after removal of the foreign body due to septic shock and multi-visceral failure. During the extraction foreign body, bacteria could be disseminated into the systemic circulation and might cause septic shock. Thus, wide-spectrum antibiotic therapy must be used before the procedure, which may decrease the chance of septic shock.

Effect of Freeze-dried Amnion with Human Amniotic Stem Cells Seeding on the Expression of FGF-2 and the Number of Fibroblasts in Vesicovaginal Fistula: An Animal Study

Surgery is the standard therapy for vesicovaginal fistula. The surgical success rate in these cases ranges from 70-100%, and the risk of recurrence is high. The human amniotic membrane is especially being developed for tissue engineering in urogynecology. The study aimed to determine the effect of freeze-dried amnion with human amniotic stem cells seeding on the expression of FGF-2 and the number of fibroblasts in vesicovaginal fistula in New Zealand rabbits. We conducted experimental research with a post-test-only control group design. The female rabbits were divided into three groups, each consisting of 12 rabbits. The specimens taken were subjected to immunohistochemical staining to determine the expression of FGF-2 and hematoxylin-eosin staining to determine the number of fibroblast cells. We analyzed data statistically. The expression of FGF-2 in primary suturing and freeze-dried amnion with human amniotic stem cell seeding was higher than in the other groups (P&lt;0.05). We found the highest fibroblast cells in the primary suturing and freeze-dried amnion with human amniotic stem cell seeding (P&lt;0.05). The use of freeze-dried amnion with the seeding of human amniotic stem cells affects postoperative wound healing seen from the expression of FGF-2 and the number of fibroblasts. This study can be used as a recommendation for clinical use but needs to be clarified by conducting human studies.

Post Hysterectomy Vesicovaginal Fistula Repair Without Vaginal Vault Closure - A Simple Laparoscopic Extravesical Repair Approach

Purpose: The purpose of this study is to describe a simple extravesical laparoscopic approach for supratrigonal vesicovaginal fistula (VVF) repair without cystotomy and closer of the vaginal vault. Materials and Methods: This retrospective observational study reviewed data of 36 patients from January 2015 to January 2020. In our technique, the fistula tract was identified without cystotomy with the help of preplaced ureteric catheter in VVF tract. After meticulous extravesical dissection of the fistula tract, the bladder wall was closed in a single layer using polyglactin 2.0 sutures. The omental flap was approximated over the vaginal vault without primary closer of the vault. Results: In most of the patients the fistula opening were located 2 cm away from ureteric orifice while in 4 patients it located within 2 cm of orifice. The mean operative time was 86 min (65–125) and estimated blood loss was 94 ml (40–130). The mean size of fistula was 7.1 mm (5–15 mm). Omental flap was approximate over vaginal opening in most of the patients. The average hospital stay of patients was 5 days. In all patients, Foley catheter was removed on day 14 after cystogram. The mean follow-up of patients was 4.2 months (3–7). All patients remained continent and symptom free during the follow-up periods. Conclusion: Our technique without suturing of the vaginal vault in laparoscopic VVF repair is safe in a simple supratrigonal fistula with good results and avoiding added suturing.

Urinary Bladder Calculus as a Rare Cause of Obstructed Labour: A Series of Three Rare Cases

Obstructed labour by large urinary bladder stones is one of the rare complications. Very small number of cases have been described in available literature. The diagnosis is generally based on the history of patient, their clinical evaluation and ultrasonography scans during pregnancy. Majority of antenatal cases in rural areas come first time in Primary Healthcare Centre (PHC) with labour pain and usually without any previous ultrasound scans. These cases are referred to higher centres due to prolonged obstructed labour. Although rare, but one should consider a large urinary bladder calculus as a cause of obstructed labour as early diagnosis and timely management of urinary bladder stones can prevent various complications like mechanical dystocia and Vesico-vaginal Fistula (VVF). Here authors report three cases of a large urinary bladder calculus causing obstructed labour. Caesarean section was done for obstructed labour and cystolithotomy was performed simultaneously in all three cases.

Transient urocolpos due to vesicovaginal reflux in a 37-year-old woman: a case report

Urocolpos is a urine collection in the vagina, possibly due to vesicovaginal reflux (VVR) or a fistula. Urocolpos is a rare phenomenon in adults, and it is commonly underrecognized by radiologists. The occurrence of urocolpos due to VVR after a Caesarean section in adult females is a rare phenomenon; failure to recognize it may lead to misdiagnosis as vesicovaginal fistula and often leads to unnecessary medical interventions. We report a 37-year-old female who complained of abdominal pain and intermittent daytime urinary incontinence for six months, starting after a Caesarean section for her third baby. An abdominal computed tomography scan revealed a large fluid-filled vagina on a full bladder without anatomical abnormality. A post-voiding scan showed a complete resolution. In conclusion, urocolpos is an underrecognized entity that rarely coexists with VVR. Post-voiding resolution and vaginal contrast reflux are important findings that can aid radiologists in identifying such cases.

Prospective Study on Clinical Outcomes of Laparoscopic Repair of Vesicovaginal Fistula with V-Loc 90 Suture

1.1. Objective To study feasibility , efficacy and postoperative outcomes of laparoscopic vesicovaginal repair with barbed, resorbable 3-0 V-Loc 90 sutures. 1.2. Methods Patients presented with vesicovaginal fistula and failed with more than 3 weeks of bladder drainage using a foley catheter are selected for study. The cases where the fistula can be approached via vaginal route adequately without episiotomy or moderate to heavy traction, recurrent cases, complex fistulas , post radiation and malignant fistula are excluded from this study. 1.3. Results In our study from March 2019 to November 2021, total 15 patients were enlisted for laparoscopic VVF repair using V-Loc suture. The main objective of laparoscopic repair of VVF is rapid cessation of urinary leakage with early return of normal and complete urinary and genital function. The most common cause of VVF in our studies was hysterectomy 12 (80%), caesarean section 3 cases (20%) . In our study in all cases laparoscopic transperitoneal transvesical mini-O’ Conor approach with an interposition of omental graft or appendices epiploicae were adopted. In our study all fistulas were supratrigonal with average size of 1.8 cm (range 0.8 to 3.4 cm). Mean age of patients undergoing VVF repair was 39.9 years (range 26 to 48years) . Estimated blood loss was 63 ml (range 30 ml to 160 ml) , and mean operative time 130 minutes (range 100 to 190 minutes). There was no serious intraoperative or postoperative complications including: conversion to open procedure, denying operative procedure, vascular, bowel or ureteric injury, blood transfusion, blood clots, pulmonary embolism, cardiac events or strokes. Length of hospital stay was mean 5.2 days (range 3 to 8 days). Patients were instructed to return our outpatient department 14 to 21 days after surgery for cystogram, cystoscopic and vaginal inspection to confirm successful VVF repair and subsequent suprapubic catheter removal. At a mean of 14.7 months (range 6 to 37 months) no recurrence of VVF occurred with success rate is 100% (15 out of 15 patients). 1.4. Conclusions In the era of minimally invasive surgery, it is difficult to deny its role in the management of VVF. It can be performed safely and effectively with shorter operative time. It seems to offer patients a shorter hospital stay, less morbidity , quicker convalescence, better cosmesis and equal efficacy. Technically, laparoscopy provides better visualization through magnification, but is more difficult to learn, as is intracorporeal suturing. Use of resorbable continuous barbed sutures (V-Loc) simplify the technique and reduce the time of surgery while avoiding implementation of knots. Successful treatment using a laparoscopic approach in VVF is highly dependent on the surgeon’s experience, tissue conditions around fistulae, tension-free watertight closure, and adequate postoperative urinary drainage

Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results.

PurposeThe aim of the study was to report the outcomes of pre-operative high-dose-rate brachytherapy (pHDR-BT), followed by hysterectomy in patients with early cervical cancer.Material and methodsFrom January, 1998 to December, 2003, 113 women with IB1, IB2, and IIA1 cervical cancer (according to International Federation of Gynecology and Obstetrics [FIGO] 2018) were treated with pHDR-BT, and 6 to 8 weeks later followed by radical hysterectomy. Patients found to have positive lymph nodes, residual cervical cancer, involved parametria, or lymphovascular space invasion (LVSI) received post-operative adjuvant therapy.ResultsPost-operatively, 81.4% of patients had a complete response to pHDR-BT in the cervix, and 18.6% had residual cervical cancer. Failures occurred in 11/113 (9.7%) patients (all were stage IIA1), with pelvic recurrences in 5/113 (4.4%) and distant metastasis (DM) in 6/113 (5.3%). The 5- and 10-year disease-free survival (DFS) rates were 100% for IB1 and IB2, and 86.4% and 81.3% for IIA1, respectively. Lymph node involvement and/or residual cervical cancer correlated with worse DFS. Two vesicovaginal fistulas were observed (one in a patient treated only with pHDR-BT and one in a woman, who underwent adjuvant external-beam radiotherapy [EBRT]). Two rectovaginal fistulas and one case of proctitis were observed in patients treated with adjuvant EBRT.ConclusionspHDR-BT in early cervical cancer is well-tolerated and effective in sterilizing tumor cells in the cervix. The growing number of publications in this area may help define an optimal therapeutic scheme, but randomized trials are required to determine the best candidates for this treatment modality.In our opinion, cervical cancer patients with FIGO stage IIA1 are not good candidates for pHDR-BT, and could be given this treatment only after rigorous selection, including assessment with state-of-the-art imaging, due to higher probability of treatment failure.

Dual diagnostic conundrum after uterine surgeries; urinary incontinence and total hematuria: Two case reports of vesicouterine fistula and literature review

The process leading to diagnosis starts with active inquiry into the origin and the evaluation of the presenting problem; known as history taking, the clinician takes his time to inquire about the problem of the patient from its onset and gradually walk himself through the course of the problem with the possible causes in mind. Thus, history taking forms the backbone of every diagnosis. Two patients came to our facility with two different presentations; urinary incontinence and total hematuria but share a similarity on onset of the problem; both patients had uterine surgery each about a week or two from the onset of the presenting complain.First patient is a 40 years old house wife who presents with pain during micturition and total hematuria which began two weeks after she had a myomectomy, the pain was described as dull aching not radiating nor referred, no associated suprapubic pain, no lower urinary obstructive or irritation symptoms, no history of trauma to the abdomen, no passage of stone in urine and no previous history of similar occurrence in the past, no history of weight loss or anorexia and she is not a known hypertensive or diabetic. All possible causes of hematuria were considered and ruled out. On diagnostic Urethrocystoscopy a point of communication was noticed at the posterior wall of the bladder with seepage of menstrual blood from the uterus into the bladder.Second patient is a 35-year old para 9 + 1 patient who had delivery by caesarian section about 3 weeks prior to presentation after which she noticed leakage of urine per vaginum. She has had previous delivery by caesarian section on her 8th pregnancy and had a trial of delivery after a caesarian section (VBAC) which failed due to malposition and cephalopelvic disproportion (CPD) and this necessitated the emergency caesarian section which she had prior to the onset of the presenting complain. She was being evaluated for vesicovaginal fistula (VVF), but on speculum examination urine was notice to seep from the cervical Os. Urethrocystoscopy and perineal examination with dye in the bladder shows a communication at the posterior lateral wall of the bladder with seepage of urine into the uterus from the bladder.These are two cases each with a previous history of a uterine surgery prior to the onset of the presenting complain with no any other identifiable possible cause of the presentation, each needed a urethrocystoscopy to identify a vesicouterine fistula. The direction of flow between the two organs connected by the fistula depended on the intra cavity pressure and the site of the fistula.

The Tissue Structure in the Remodeling Phase of a Vesicovaginal Fistula between the use of Freeze-Dried Amnion and Primary Suturing in Rabbit

The Tissue Structure in the Remodeling Phase of a Vesicovaginal Fistula between the use of Freeze-Dried Amnion and Primary Suturing in Rabbit

Repair of vesico-vaginal fistula near ureteral opening after McDonald’s cervical cerclage

Repair of vesico-vaginal fistula near ureteral opening after McDonald’s cervical cerclage

Martius Graft Repair of Vesico-Vaginal Fistula: Experience at A Tertiary Care Center in Bangladesh

Background: Vesico-Vaginal Fistula (VVF) is a pathology with severe social repercussions. Resolution of VVF can be achieved through multiple surgical, abdominal or vaginal techniques, which will generally depend on the fistula's characteristics and the surgeon's experience. In this study we describe our experience with vaginal approach to treat VVF using Martius graft repair.&#x0D; Materials and methods: This prospective observational study included 50 VVF patients operated in the fistula center of Chittagong Medical College Hospital, during the period of January 2013 to December 2014. The success rate and complications of Martius graft repair of VVF.&#x0D; Results: The leading age group was 26 to 35 years (50.0%) and age range from 16 to 60 years with a mean age of 32.1 (±SD 8.10) years. The majority (72.0%) was from low socioeconomic class and had short stature (64.0%).48% fistula was midvaginal, 28% was juxtracervical and 54% was &lt;2 cm in size and 40% were associated with vaginal stenosis and urethral avulsion. In 36% cases postoperative complication were developed. 82% patients were fully cured, 6% cured with urethral incontinence, 2% cured with vaginal stenosis and in 10% cases surgery was failed.&#x0D; Conclusions: The vaginal technique for the treatment of VVF reinforced by Martius graft is safe and effective with low rate of complications.&#x0D; JCMCTA 2021 ; 32 (2) : 85-89

A Fictitious Replicated Display about the Effect of Physiotherapy and Health Education Programs on the Surgical Repair of Vesico-Vaginal Fistula

Objectives: Surgery is the only effective therapy for the majority of Vesico-Vaginal (V-V) fistulae. The current research assessed the effect of a planned program of pre- and postoperative physiotherapy and health education on the outcome of V-V fistula surgery. Methods: We examined the postoperative outcomes of two groups of women with V-V fistulae recruited and followed up on by two local nonprofit organizations at a hospital in Saudi Arabia on April-October 2021. The first group of women (n = 99) underwent fistula repair using conventional procedures. The second group (n = 112) had a standardized surgical technique as well as a systematic pre- and postoperative health education and physiotherapy regimen. Results: The training had a strong favorable influence on overall recovery and urine incontinence in particular. The chances of recovery after physiotherapy were 2.7 times higher for women in the physiotherapy group than for control patients, and the likelihood of postoperative stress incontinence was significantly higher for patients in the control group than for those in the physiotherapy group (P value 0.001). Conclusion: A planned program of health education and physiotherapy provided by skilled nurses and physiotherapists increases the chance of a satisfactory result after V-V fistula repair surgery.