Contemporary Management of Vesicouterine Fistula

Vesicouterine fistula (VUF) is an uncommon complication that predominantly occurs after cesarean delivery. Current evidence regarding its diagnosis and management is limited and largely derived from small retrospective studies.

The objective was to evaluate the etiological factors, clinical characteristics, diagnostic approaches, and surgical outcomes associated with VUF through a systematic review and proportional meta-analysis.

This systematic review and proportional meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed/MEDLINE and Web of Science databases identified studies published between 2006 and 2026. Studies including at least 8 patients with VUF and reporting clinical or surgical outcomes were eligible. Pooled prevalence estimates with 95% CIs were calculated using random-effects models.

Eight retrospective studies involving 447 patients were included. Cesarean delivery was the predominant etiological factor (pooled proportion, 95.3%), while a history of repeat cesarean delivery was identified in 78.4% of patients. Cyclic hematuria represented the most characteristic symptom. Cystoscopy was the most frequently used diagnostic modality. Surgical treatment demonstrated a pooled success rate of 97.1%, with low recurrence and postoperative complication rates of 4.3% and 5.6%, respectively. Open abdominal repair remained the most common surgical approach, although minimally invasive surgery was increasingly reported.

Vesicouterine fistula has evolved into a predominantly cesarean delivery-related iatrogenic condition with diverse clinical manifestations. Surgical repair provides excellent outcomes with low recurrence when appropriate reconstructive principles are followed. Although the pooled surgical success rate of 97.1% is impressive, this estimate is derived entirely from retrospective observational studies, several of which are small case series. Minimally invasive surgery is a feasible option in selected patients, but comparative evidence is insufficient to determine whether it improves perioperative or long-term outcomes relative to open abdominal repair.