Successful Treatment of Vesicovaginal Fistulas via an Abdominal Transvesical Approach: A Single-center 50-yr Experience

Background: A vesicovaginal fistula (VVF) is an abnormal communication between bladder and vagina, as a result of traumatic events to the female pelvis. A VVF is a rare event and challenging to cure. Successful treatment can be achieved through an abdominal approach, especially in complex or recurrent cases. This approach has been used in our institution as the procedure of choice for the past 50 yr. Objective: To analyze the results of the management of VVFs in our institution and to highlight the key points for success. Design, setting, and participants: A total of 138 patients with VVFs have been treated in our institution between 1969 and 2019. Up to now, this is the largest series reported so far on abdominal treatment of VVFs in the developed world. Intervention: an abdominal transvesical approach has been performed as the procedure of choice. Outcome measurements and statistical analysis: to evaluate the factors influencing the success rate of the abdominal approach at the first closure attempt. Statistical analysis was performed using STATA software. Results and limitations: In total, 124 (90%) patients were submitted to transabdominal repair (89 extraperitoneal; 71.8%), 113 (91.1%) presented with a VVF not associated with another fistula, and 36 (29.0%) had undergone previous unsuccessful treatments elsewhere. Successful closure was obtained in 111/118 (94.1%) patients at the first attempt, excluding external noncontinent urinary diversions. Follow-up was possible in 95 (76.6%) patients; 91 (95.8%) patients were dry. Statistical analysis showed a significant association between fistula size and length, and VVF site in the bladder and extraperitoneal approach. Success rate decreased with the number of previous attempts and did not vary with VVF etiology. Conclusions: The abdominal approach for the treatment of VVF has a high success rate. Standardization of the technique, identification of surgical key points, and centralization of care in centers with experience are critical. Patient summary: A vesicovaginal fistula (VVF) is a rare clinical condition, with a high impact on patients’ quality of life. We report a large series of VVFs treated in our institution in the past 50 yr. Key factors for success include proper surgical technique and centralization of care in centers with high experience. A vesicovaginal fistula is a rare challenging disease. The largest series in the developed world involve <200 cases. The goal of treatment is closure at first attempt, minimizing the chances of failure. Centralization of care in centers of expertise is crucial.