Application of single-layer vaginal flap in transvaginal repair for vesicovaginal fistula

Objectives: To compare the first-time success rate and prognosis of repairing vesicovaginal fistula (VVF) by transvaginal and transvesical approaches, and to highlight a modified transvaginal repair technique which only require single layer closure of an annular vaginal flap.

Methods: Retrospective analysis of 68 consecutive patients who underwent VVF repair between 2007 and 2022. Fistula characteristics, operative factors, post-surgical complications and outcomes were analyzed.

Results: A total of 68 women with a median age of 52.1 (27–75) years were included. The history ranged from 7 days to 8 years, with an average of 18.4 months. 67 cases (98.5%) of VVFs were caused by pelvic surgery, and only one resulted from difficult labour. 15 cases (22.1%) had a history of surgical repair failure. All 68 cases of surgery were smoothly completed. Among them, 28 patients underwent transvaginal repair, whereas 40 (58.8%) women had transvesical repair. Transvaginal approach had a significantly shorter operative time, less intraoperative blood loss, reduced postoperative hospital stay, less hospitalization cost and lower minor complication rates than transvesical group (p < 0.05). No serious complications occurred in the two groups. No cystostomy was performed in the transvaginal group, but 12 cases (30%) in the transvesical group. The average follow-up time was 17.4 (3-48) months. The first-time success rates of transvaginal and transvesical techniques were 89.3% and 75%, respectively.

Conclusions: VVF repair with single layer closure of an annular vaginal flap is a technically feasible, simple and successful approach with significantly better operative parameters and lower complications rates.