Outcomes of laparoscopic genitourinary fistula repair: A single-center study

Genitourinary fistulas, though rare, are serious complications predominantly following gynecological surgeries. Minimally invasive laparoscopic techniques have emerged as effective alternatives to open repair, offering faster recovery and reduced morbidity.

The purpose of this study is to report the surgical outcome of laparoscopic genitourinary fistula repair performed at our institution.

Fifty-eight consecutive patients who underwent laparoscopic genitourinary fistula repair at the Department of Urology, Gandhi Medical College, Bhopal, India, from December 2018 to January 2025, were included in this study. The study was conducted retrospectively by analyzing data from a prospectively maintained institutional medical records database. Among those patients, 30 had vesicovaginal fistula (VVF), 26 had ureterovaginal fistula (UVF), and 2 had vesicouterine fistula (VUF). Patients were assessed preoperatively with imaging and cystoscopy and underwent standardized laparoscopic repair based on fistula type. Outcome measures included success rate, recurrence, complications, perioperative parameters, and postoperative recovery parameters. Statistical analysis was descriptive.

Laparoscopic repair of 30 supratrigonal VVF, 26 UVF, and 2 VUF was performed. VVF was associated with abdominal hysterectomy in 20 patients, vaginal hysterectomy in 4 patients, and lower segment cesarean section (LSCS) in 6 patients. UVF was associated with abdominal hysterectomy in 22 patients, vaginal hysterectomy in 2 patients, radical hysterectomy in 1 patient, and LSCS in 1 patient. Both cases of VUF were associated with LSCS. The mean size of the VVF was 15 mm. One intraoperative bowel injury occurred during laparoscopic VVF repair and was successfully managed using the Heineke-Mikulicz repair. Two cases of VVF developed recurrence; both the cases were successfully managed with open VVF repair 3 months after the diagnosis. The success rates of VVF, UVF, and VUF were 93.33%, 100%, and 100%, respectively.

Laparoscopic genitourinary fistula repair is a reliable and effective treatment modality with high success rates and minimal morbidity. With appropriate patient selection, meticulous preoperative evaluation, and adherence to sound surgical principles, laparoscopic repair is a feasible and effective option in centers with laparoscopic expertise.