[Vesicovaginal fistulas: surgical strategy and rare clinical observations]

To present our experience of surgical management of vesicovaginal fistulas (VVFs).

From 1996 to 2025, 156 women with VVFs underwent surgical treatment at the Department of Urology, North-Western State Medical University named after I.I. Mechnikov. Age ranged from 21 to 79 years (mean 45.2+/-4.6 years). Recurrent fistulas were observed in 42 (26.9%) patients, who had previously undergone from one to six unsuccessful surgical attempts. The predominant cause of VVF formation was iatrogenic injury to the urinary bladder during gynecological interventions (77.5%). Fistula repair was performed in 140 patients, with a transvaginal approach used in 91.4% of cases. The transabdominal approach was employed in 12 women, including 10 cases with concurrent ureteral reconstruction and 2 performed via laparoscopic approach.

Among 140 patients who underwent fistula closure, success was achieved in 139 cases (99.3%).

In our clinic, transvaginal fistula closure is the preferred surgical method for managing vesicovaginal fistulas. We consider it the least traumatic open technique, even compared with its laparoscopic alternative.

Transvaginal vesicovaginal fistula closure remains the method of choice for treatment of VVFs. A transabdominal approach, including laparoscopic repair, is justified only when simultaneous ureteral reconstruction is required. Heterotopic cystoplasty is regarded as the most reliable reconstructive option for patients with radiation-induced fistulas.