Laparoscopic Transvesical Versus Extravesical Uterovesical Fistula Repair

Due to the lack of data comparing transvesical (TV) and extravesical (EV) techniques for uterovesical fistulas (UVFs), specifically comparing surgical success rates, intraoperative complications, and postoperative effect on urinary bladder (UB) capacity, we designed our study.

This study compares laparoscopic TV versus EV repair of UVFs in terms of surgical success, intraoperative complications, postoperative UB capacity, and overactive bladder (OAB) symptoms.

A retrospective observational cohort study was conducted from January 1, 2020 to January 1, 2025, upon patients aged 18 years and older who underwent laparoscopic UVF repair at Ain Shams University Hospital, Cairo, Egypt. Data were collected through a chart review of routinely administered perioperative assessments, including the Overactive Bladder 8-Question Awareness Tool (OAB-V8) and a 3-day voiding diary.

Patient demographic characteristics were similar in both groups. Success rates were similar between cohorts. One hysterectomy was performed in the EV group due to intraoperative bleeding. The EV approach had a higher complication rate than the TV group ( P =0.014). The TV approach was associated with a significantly greater reduction in UB capacity compared with the EV approach (97.73±15.39 mL vs. 37.50±22.39 mL, respectively, P =0.001). Concurrently, the TV group demonstrated a significantly higher increase in OAB-V8 scores than the EV group (6.70±0.82 vs. 1.36±0.50, respectively, P =0.001).

Both techniques demonstrated efficacy in repairing fistulas. However, the EV approach offered superior functional outcomes, with significantly better preservation of UB capacity and a lower incidence of postoperative OAB symptoms. In contrast, the TV approach may remain preferable in younger patients or those seeking uterine preservation, as it enables precise dissection and repair while minimizing risk to uterine integrity.