Vesicovaginal Fistula Research Articles

Subspecialty surgical care is limited in low- and middle-income countries (LMICs). Nongovernmental organizations (NGOs) attempt to bridge this gap through short-term medical trips (SMTs), but sustainability remains challenging. This report describes establishing a urology program in El Petén, Guatemala's largest region, as a model for sustainable subspecialty surgical care in LMICs. This retrospective, single-institution review evaluated the Aid Via Action Inc. (AVA) urology program at Hospital Nacional de San Benito (HNSB), a departmental public hospital in El Petén, Guatemala, from June 2024 to June 2025. All AVA cases were reviewed, with a descriptive analysis of program development and implementation. Institutional approval was obtained from the hospital ethics committee and director. Patient selection included medical, anesthesia, and urologic evaluation. Equipment was obtained through donations and partnerships. Sterilization used a 2% glutaraldehyde (Cydex®) protocol. Data were analyzed descriptively in Microsoft Excel, complications categorized by the Clavien-Dindo system, and follow-up conducted through clinic visits, phone calls, and coordination with local physicians. During this period, a total of 37 urologic procedures were performed: 31 TURPs, 2 cystolithotomies, 2 vesicovaginal fistula repairs, 1 cystoscopy, and 1 circumcision. There were three complications-two cases of urinary retention following TURP and one surgical-site infection (all Clavien-Dindo Class II) following a cystolithotomy. The median follow-up was 88days (IQR 73-98days). There were no mortalities. Early outcomes demonstrate the feasibility of implementing a urology program in a resource-limited setting. Long-term success depends on local engagement and sustained urology staffing at HNSB.

This study retrospectively reviewed genitourinary fistula (GUF) cases repaired at a leading tertiary care center in northern India, analyzing surgical outcomes. The study was conducted in the Department of Urology at King George's Medical University, Lucknow, from 2000 to 2024. This study obtained ethical approval from the institutional committee. Data were collected from hospital records, telephonic communication, and digital media. Obstetric and gynecologic histories, examination findings, cystoscopy, vaginoscopy results (including site, size, number of fistulae, and vaginal status), and imaging findings were documented. Operative details of open transabdominal (TA), transvaginal (TV), and laparoscopic repairs, along with surgical success rate and follow-up, were analyzed. A total of 638 GUF cases were repaired over a 25-year period. Vesicovaginal fistula (VVF) was the most common (572 cases, 89.65%), followed by ureterovaginal fistula (44 cases, 46 units, 6.89%), and urethrovaginal fistula (UVF) (12 cases, 1.88%). Hysterectomy was the leading cause (431 cases), followed by obstetric causes (175 cases), traumatic (12), radiation (5), and other causes (15). Surgical techniques included open TA (309 cases), TV (213), and laparoscopic repairs (116). The surgical success rate (cure of urinary incontinence with complete restoration of bladder and vaginal functions at 3 months) following first repairs was 93.95% (TA), 94.24% (TV), and 96.55% (laparoscopic). The surgical success rate following the second repair at 3 months was 82.05% (TA) and 82.75% (TV). No repeat laparoscopic repairs were performed. The overall success rates (combined first and second repair) were 95.78% (TA) and 95.77% (TV). The overall mean follow-up was 48 months (ranging from 3 to 120 months). Over 25 years, our single-center experience reveals a shift from obstetric to gynecologic causes of genitourinary fistulas, with hysterectomy emerging as the leading etiology. Surgical repairs via TA, TV, and laparoscopic approaches showed high success rates. A clear trend toward minimally invasive techniques was observed, reflecting advancements in surgical practice.

Role of Platelets Rich Fibrin and Martius Flap in Vesicovaginal Fistula

Effectiveness of Educational Programs in Preventing Vesicovaginal Fistula Recurrence in Northern Nigerian Women: A Community-Based Randomised Controlled Trial

This is a 56-year-old woman with a history of endometrial cancer who underwent multiple abdominal gynecological surgeries and pelvic radiation therapy. She subsequently developed a 2-cm supratrigonal vesicovaginal fistula following transurethral resection of a solitary bladder recurrence of her endometrial cancer. Given her oncologic history and the altered abdominal anatomy resulting from prior surgeries and radiation, we performed an extraperitoneal transvesical repair using transurethral illumination and laparoscopic instruments. A shorter and lightweight telescope, such as an ear, nose, and throat sinuscope, was utilized to improve surgical ergonomics. This minimally invasive approach allowed us to avoid entering the peritoneal cavity, thereby reducing the risk of organ injury associated with transabdominal repair in such complex cases. To illustrate this technique, we present this case report with step-by-step procedural guidance.

Female lower urinary tract symptoms (FLUTS) are common but often underrecognized, particularly in low-resource settings such as the Democratic Republic of Congo (DRC). This study was aimed at assessing the prevalence, severity, and associated factors of FLUTS in the DRC. A community-based cross-sectional study was conducted between 2021 and 2023 across six provinces in the DRC. A total of 507 women (≥ 18 years old) were recruited using a multistage, geographically and ethnolinguistically stratified sampling approach. Pregnant and postpartum women (≤ 6 months), survivors of sexual violence, and those with vesicovaginal fistulas were excluded. Data collection included the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Multivariable logistic regression identified risk factors. The prevalence of any FLUTS was 77.3% (95% CI: 73.4-80.9%), with storage symptoms (75.9%) more common than voiding symptoms (8.1%). Nocturia (63.1%), urgency (41.6%), and urgency urinary incontinence (26.8%) were the most common storage symptoms, whereas hesitancy (5.9%) and straining (3%) were the most frequent voiding symptoms. Among women with LUTS, 30.1% reported discomfort, mostly linked to insensible incontinence (100%), stress urinary incontinence (61.1%), and nocturnal enuresis (62.9%). High parity (aOR: 1.09; 95% CI: 1.01-1.19) and a profession involving high-intensity physical activity (aOR: 1.60; 95% CI: 1.01-2.55) were significant risk factors for FLUTS. Lower urinary tract symptoms are highly prevalent among Congolese women, but only a third experience significant discomfort. Targeted interventions are needed to improve awareness, prevention, and management strategies to inform national-health policies and strengthen community-level interventions.

ABSTRACTIntroductionWe report a case of vesicovaginal fistula (VVF) following transvaginal mesh (TVM) surgery that was successfully treated conservatively using a urethral catheter with low‐pressure intermittent suction.Case PresentationA 78‐year‐old woman underwent TVM surgery for cystocele. During the surgery, bladder perforation occurred, which was repaired transvaginally. After the urethral catheter removal, she was diagnosed with VVF. We reinserted a new urethral catheter and added low‐pressure intermittent suction to the catheter, which gradually decreased the amount of incontinence, and the patient was successfully cured.ConclusionUrethral catheter with low‐pressure intermittent suction may be an option when catheterization alone does not provide adequate drainage of VVF.

Transvaginal apical vesicovaginal fistula repair: Anatomical basis for direct transvaginal surgery, vaginal natural orifice transluminal endoscopic surgery (V-NOTES) including single-port robotic assisted surgery

This is a case of a primigravid woman in her 20s who had prolonged labour complicated by shoulder dystocia and had emergency low transverse caesarean section. Postoperatively, the patient had continuous urine leakage per vagina and was assessed with a vesico-utero-vaginal (juxtacervical) fistula which was successfully repaired abdominally using modified O'Connor technique, cervical reconstruction and vaginal advancement flap.Vesicovaginal fistula from obstructed labour affects women in low-resource settings. This highlights the importance of addressing and repairing these fistulas to improve quality of life.

To synthesize the current literature regarding the evaluation and management of genitourinary fistula in women. Genitourinary fistula are aberrant communications between the urinary tract and genital tract that present with urinary leakage per the vagina. Initial management often involves conservative measures, such as urethral catheter or ureteral stent placement, progressing to surgical repair when needed. Key surgical principles include a tension-free, watertight closure with well-vascularized tissue including tissue interposition as appropriate, and postoperative urinary drainage. When surgical management of vesicovaginal fistula is necessary, a transvaginal repair is the most common. Other minimally invasive approaches are increasing and result in similarly high success rates with lower patient morbidity compared to open abdominal surgeries. The initial management of ureterovaginal fistula commonly includes ureteral stent placement. When not feasible or in persistent fistula, laparoscopic and robotic surgical repair with ureteral reconstruction offers high success rates with lower morbidity than an open approach. Successful management of genitourinary fistula ranges from conservative urinary tract drainage to surgical interventions based on etiology, location, and complexity. Approaches to repair are shifting toward less invasive procedures. With optimal technique and surgical planning, high success rates can be achieved, particularly in primary repairs.

IntroductionVesicovaginal fistula (VVF) is an abnormal communication between the bladder and vagina that leads to continuous involuntary urine leakage and profoundly affects quality of life. In developed countries, most cases are iatrogenic, often following hysterectomy. Laparoscopic repair has emerged as a minimally invasive option with promising outcomes. This study aims to describe the experience of a tertiary referral center with laparoscopic repair of VVF.MethodsA retrospective descriptive study was conducted at a university hospital in Monterrey, Mexico, between March 2023 and March 2025. Seven patients who underwent laparoscopic VVF repair were included. Preoperative evaluation involved clinical, imaging, and endoscopic assessment. All repairs were performed using the O’Conor technique with omental interposition. Perioperative variables and outcomes were analyzed.ResultsAll VVFs were secondary to gynecological surgery (six abdominal hysterectomies and one vaginal hysterectomy). The mean patient age was 48 ± 6.2 years, with a BMI of 29.3 ± 3.8 kg/m². The mean time from hysterectomy to repair was 14.7 ± 8.6 months. Six fistulas were classified as simple and one as complex. Mean fistula size was 20 (15.0 - 20.0) mm, and 71.42% were supratrigonal. Mean operative time was 235.71 ± 155.52 minutes, with no conversions to open surgery. The average hospital stay was 2.7 ± 1.38 days, and Foley catheter removal occurred at 20.86 ± 3.53 days. No intraoperative or postoperative complications were observed, and no recurrences were noted during a mean follow-up of 2.57 ± 0.79 months.ConclusionLaparoscopic repair of VVF is a safe and effective surgical option, with favorable outcomes and minimal morbidity, particularly when standardized surgical principles are applied and omentum is used as an interpositional tissue. Further prospective studies are needed to define its role in broader clinical practice

ABSTRACT Congenital vesicovaginal fistula (VVF) with distal vaginal agenesis (DVA) is an extremely rare anomaly and isn’t easy to diagnose. To detect VVF in DVA, waiting until adolescence for the operation and performing cystoscopy during the menstrual period will ensure a correct diagnosis. Here, a girl with this anomaly is presented.

Introduction: Urogenital fistulas represent a debilitating condition that compromises urinary and reproductive function, with profound psychosocial impacts. Surgical repair remains the mainstay of treatment, with flap-based reconstruction offering anatomic and functional restoration. Both local and free flap techniques are employed depending on fistula complexity, tissue availability, and previous surgical history. Objective: To evaluate current evidence on the surgical repair of urogenital fistulas using local and free flap techniques, highlighting indications, techniques, outcomes, and complication rates. Methods: A narrative literature review was conducted using PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. Studies published between 2019 and 2025 were included if they reported on surgical flap-based approaches to vesicovaginal, rectovaginal, or urethrovaginal fistulas. Results and Discussion: Local flaps such as Martius, gracilis, and labial advancement flaps are commonly used for low-complexity cases, while free flaps are reserved for extensive or recurrent fistulas. Flap selection impacts surgical success, tissue viability, and continence restoration. Outcomes are enhanced with multidisciplinary preoperative planning and careful patient selection. Conclusion: Flap-based reconstruction of urogenital fistulas remains a cornerstone in complex pelvic reconstructive surgery. Surgeons should be well-versed in a range of flap techniques to tailor interventions to individual anatomical and clinical contexts.

ABSTRACTIntroductionWe report a case of bladder eversion through a vesicovaginal fistula (VVF) in an elderly patient with severe pelvic organ prolapse (POP).Case PresentationA 90‐year‐old woman presented with a sensation of prolapse and urinary leakage. She was diagnosed with complete uterine prolapse and bladder mucosal ectropion through a VVF, with renal dysfunction due to bilateral hydronephrosis. A one‐stage minimally invasive surgical repair was performed. The VVF was then closed in two layers and reinforced with a Martius flap. Colpocleisis was performed without the addition of transvaginal hysterectomy. At 18 months after surgery, the patient remained free of POP and urinary incontinence.ConclusionIn elderly patients, VVF can develop in advanced POP. Minimally invasive treatment is desirable, and early intervention for POP may help prevent this complication.

Introduction: Complex vesicovaginal fistula (VVF) is a debilitating condition that often results from obstetric trauma, surgical injury, or radiation, posing significant challenges to surgical repair and postoperative recovery. Objective: To assess the impact of surgical repair in complex vesicovaginal fistula patients. To assess the impact of surgical repair in patients with complex vesicovaginal fistula. Materials and Method: The study was done prospectively at a prospective observational study at Department of Urology, Armed Forces Institute of Urology from January 03, 2025 and May 15, 2025. Thirty-two complex VVF patients were recruited. Based on the nature of the fistula, surgical repairs were done by using a transvaginal or transabdominal fashion. Two and six weeks were used to investigate postoperative numbers. Results: There was complete closure in 81.25 percent of the patients. There was partial healing in 12.5% and failed repair in 6.25%. Tissue flaps and use were linked with a better surgical outcome. There were worse prognoses of radiation-induced and recurrent fistulae. Conclusion: Surgical repair of complex VVF yields favorable outcomes when guided by careful assessment, technique, and postoperative care, though prevention remains crucial.

Background The aim of this study was to report the institutional experience with robot-assisted trans-vesical vesico-vaginal fistula (VVF) repair focusing on technical points. Methods Patients diagnosed with VVF who came to our observation between December 2020 and January 2024 were included in the analysis. Beyond computed tomography scan, all patients underwent pre-operative cystoscopy; a cystography could also be executed. All patients were scheduled for robot-assisted repair with trans-vesical approach. Results Five VVFs were developed after previous gynecological surgery, while one occurred after a urological surgical procedure. The median operative time was 137 min [interquartile range (IQR) (99–150)]. Intraoperative blood loss was negligible. The average hospital stay was six days. The urinary catheter was removed within four weeks (median catheterization time, 16.5 days) (IQR 14–27) after cystography was negative for leakages. One patient reported fever within three months from surgery (Clavien II). Pathology reports were negative for malignancies in all cases. No recurrences were reported during the follow-up. Conclusions Robotic repair of VVF with a trans-vesical approach represents a safe and effective surgical option.

A Rare Conundrum of Transvaginal Mesh Causing Urethral Stricture & Vesico-vaginal Fistula, Compounded with Bilateral Ureterocoeles: A Case Report

Vesicovaginal fistula formation after cervical cerclage.

Repair of Vesicovaginal Fistula in 12 Steps Using the da Vinci Surgical System.

Trends and Outcomes of Ureteral and Bladder Injury Intraoperatively Repaired During Open and Minimally Invasive Hysterectomy From 2013 to 2023: A National Matched Cohort Study.