Surgical Outcomes of Lower Genitourinary Fistula Repair: A Prospective Cohort Study From an Indian Tertiary Hospital

Lower genitourinary tract fistulas remain a debilitating condition causing continuous urinary leakage, with vesicovaginal fistula (VVF) being the most common subtype. Despite advances in minimally invasive techniques, the optimal surgical approach remains debated. This study aimed to evaluate and compare the short-term surgical outcomes of laparoscopic, open transabdominal, and transvaginal fistula repairs, while assessing the influence of fistula characteristics, recurrence status, and interposition techniques on success rates.

In this prospective study, 104 women underwent surgical repair: VVF (n=81, 77.8%), ureterovaginal fistula (UVF; n=15, 14.4%), vesicouterine fistula (VUF; n=4, 3.8%), and urethrovaginal fistula (UVVF; n=4, 3.8%). Preoperative evaluation included cystoscopy, vaginoscopy, and selective imaging. Surgical approaches were tailored by fistula site, size, and complexity. Interposition techniques (omental flap, Martius flap, or Surgicel scaffold) and adjunctive procedures (ureteric reimplantation, augmentation cystoplasty, Boari flap, and psoas hitch) were used as indicated. The primary outcome was fistula closure at three months.

At three-month follow-up, the overall success rate was 97 (93.3%). Among VVFs, closure rates were comparable: laparoscopic (n=18, 90%), open (n=32, 94.1%), and transvaginal (n=25, 92.6%) (p=0.856). All UVF (n=15, 100%), VUF (n=4, 100%), and UVVF (n=4, 100%) cases were successfully treated. Perioperative outcomes favored the transvaginal route for the shortest operative time, while laparoscopy reduced blood loss and hospital stay compared to open repair. Postoperative complications (Clavien-Dindo ≥II) occurred only in the VVF group (n=10, 12.3%).

Surgical repair of lower genitourinary fistulas achieved high short-term success across laparoscopic, open, and transvaginal approaches. Success rates were comparable, while perioperative profiles differed: transvaginal repair minimized operative time, laparoscopy reduced blood loss and hospital stay, and open repair was advantageous for complex cases. Tailoring the surgical approach to fistula characteristics ensures optimal outcomes.