Prognostic Factors of Transvaginal Repair for Vesicovaginal Fistulas: A 5-Year Single-Center Study

Vesicovaginal fistula (VVF) causes significant physical and psychosocial morbidity. Transvaginal repair, although generally safer than the abdominal route, lacks guideline-defined predictors of surgical success. However, recent trials have suggested that certain factors may influence surgical success.

This retrospective study was conducted in a single-center hospital in Jakarta, Indonesia, between January 2020 and December 2024. Fistulas were classified using the Goh and Waaldijk systems. Data on patient demographics were collected preoperatively, and data on surgical success were collected during the 3-month follow-up period. Early repair refers to surgical intervention performed within the first 4 weeks. Univariate associations were assessed using chi-square or Fisher's exact tests and relative risk (RR). Independent predictors of surgical success were evaluated using Firth logistic regression, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

The mean age was 42.7 years; 65% had obstetric-related fistulas. Overall, 68 patients (85%) achieved successful repair. Early repair (<4 weeks) had higher success than delayed repair (94.4% vs. 77.3%; p = 0.032, RR ≈ 1.22). Small fistula size (<3 cm) and minimal fibrosis were also associated with higher success rates (89.7% vs. 58.3%, p = 0.005, RR ≈ 1.54; 88.6% vs. 60%, p = 0.018, RR ≈ 1.48). Firth logistic regression confirmed that late repair (OR 0.007, 95% CI 0.00002-0.16, p < 0.001), large fistula size (OR 0.0819, 95% CI 0.019-0.32, p < 0.001), and severe fibrosis (OR 0.0014, 95% CI 0.000004-0.032, p < 0.001) independently reduced the odds of repair.

Early intervention, small fistula size, and minimal fibrosis are independent predictors of successful transvaginal VVF repair. Preoperative evaluation of these factors can guide surgical planning and patient counseling.