Surgical Management of Urogenital Fistulas

The surgical management of urogenital fistulas, abnormal communications between the urinary tract and the genital tract, spans a range of techniques tailored to fistula type, aetiology and patient factors. Vesicovaginal fistulas represent the most common form, arising from obstetric trauma in low-resource settings and iatrogenic injury, such as hysterectomy or pelvic radiation, in high-income nations. Surgical approaches include transvaginal, transabdominal and minimally invasive routes, with the choice guided by fistula location, size and tissue quality. Transvaginal repair is favoured for simple fistulas due to reduced morbidity and shorter hospital stay, while complex or recurrent fistulas often require transabdominal or laparoscopic access to facilitate tissue interposition and ureteric reconstruction. Advances in robotic surgery have refined suturing precision and enabled enhanced recovery. Key principles include meticulous dissection, multilayer closure and use of healthy tissue interposition flaps, such as omentum or adipose pedicles, to bolster healing and minimise recurrence. Timing of repair depends on local inflammation and radiation effects, with delayed procedures advised following pelvic radiotherapy. Multidisciplinary collaboration and patient-centred care remain central to optimising functional and quality-of-life outcomes across diverse health systems.

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Surgical Management of Urogenital Fistulas publication trend

The graph below shows the total number of articles in surgical management of urogenital fistulas across all publications each year (not limited to Nature Index journals).

Technical terms

Vesicovaginal fistula: An abnormal tract between the bladder and the vagina causing urinary leakage.

Transvaginal approach: Surgical access through the vaginal canal to repair pelvic fistulas.

Omental flap: A pedicled piece of fatty peritoneum used to interpose and support fistula repair.

Supratrigonal fistula: A vesicovaginal fistula located above the bladder trigone, often amenable to vaginal repair.

Robotic-assisted laparoscopy: Minimally invasive technique using robotic devices to enhance surgeon dexterity and visualisation.

References

1. Update on vesicovaginal fistula: A systematic review. Arab Journal of Urology (2019).
2. Laparoscopic extravesical vesicovaginal fistula repair: our technique and 15-year experience. International Urogynecology Journal (2014).
3. Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach. Indian Journal of Urology (2007).
4. Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series. International braz j urol (2014).
5. The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae. International Urogynecology Journal (2019).
6. Vesicovaginal Fistulas: Prevalence, Impact, and Management Challenges. Medicina (2023).