Laparoscopic Transvesical Versus Extravesical Uterovesical Fistula Repair

Area of Science:

• Urology
• Gynecologic Surgery
• Minimally Invasive Surgery

Background:

• Uterovesical fistulas (UVFs) are rare but challenging conditions often requiring surgical intervention.
• Limited comparative data exists for laparoscopic transvesical (TV) versus extravesical (EV) repair techniques regarding functional outcomes.

Purpose of the Study:

• To compare laparoscopic TV and EV repair of UVFs.
• To evaluate surgical success rates, intraoperative complications, postoperative urinary bladder (UB) capacity, and overactive bladder (OAB) symptoms.

Main Methods:

• Retrospective observational cohort study (January 2020 - January 2025).
• Patients aged 18+ undergoing laparoscopic UVF repair at Ain Shams University Hospital.
• Data collected via chart review, including OAB-V8 questionnaire and 3-day voiding diary.

Main Results:

• Demographics were similar; success rates were comparable between TV and EV groups.
• The EV approach had a higher complication rate (P=0.014).
• TV repair led to greater reduction in UB capacity (97.7 mL vs. 37.5 mL, P=0.001) and increased OAB symptoms (6.70 vs. 1.36 score, P=0.001) compared to EV.

Conclusions:

• Both TV and EV laparoscopic techniques are effective for UVF repair.
• The EV approach demonstrates superior functional outcomes, preserving UB capacity and reducing postoperative OAB symptoms.
• The TV approach may be considered for younger patients or those prioritizing uterine preservation due to precise dissection.