Vesicovaginal Fistulas: A Combined Gynecological and Urological Perspective on Surgical Management and Outcomes

Vesicovaginal fistulas (VVFs) are a distressing condition that has been shown to have a detrimental effect on the quality of life of those affected (Smith et al., 2022). The present study aims to evaluate and compare a variety of surgical procedures for the treatment of VVFs with postoperative results. Methodology: A retrospective analysis of patients diagnosed with VVF and subjected to surgical repair from various hospitals in Iraq between May 1, 2023, and March 1, 2025, was conducted. The surgical techniques employed encompassed vaginal repair, abdominal repair, and flap repair techniques. Preoperative assessment included imaging studies, i.e., MRI or cystoscopy, to define the site and size of the fistula. Postoperative assessment was based on healing rate, complications, and quality of life as reported by patients. The mean age of the participants was found to be 35.6 ± 8.1 years, and no statistically significant difference was observed between the two groups (laparoscopic: 35.2 ± 8.3; open: 36.1 ± 7.9) (p = 0.43). The duration of incontinence was also examined. The average duration for the entire group was 12.8 ± 6.0 months, with no significant difference observed between the two groups (Laparoscopic: 12.4 ± 5.8; Open: 13.1 ± 6.3, p = 0.51). The distribution of patients according to the type of fistula is as follows: Congenital Fistula: Laparoscopic: 5 (4.3%), Open: 3 (2.6%), Total: 8 (3.5%) (p = 0.62) and Acquired Fistula: Predominantly represented, Laparoscopic: 110 (95.7%), Open: 112 (97.4%) (p = 0.62). Postoperative complications were observed in 10 (8.7%) of the laparoscopic group and 20 (17.4%) of the open group (p = 0.03). There was no significant difference in the incidence of infectious complications between the two groups (p = 0.21), with five (4.3%) cases observed in the laparoscopic group compared to 10 (8.7%) in the open group. Reoperation was necessary in 11 (9.5%) cases. The laparoscopic group did not undergo any reoperations, in contrast to two (1.7%) in the open group (p = 0.50). The average age of the participants was found to be 35.6 ± 8.1 years, with no statistically significant difference observed between the groups (p = 0.43). The duration of incontinence was also analysed. The average duration for the entire group was 12.8 ± 6.0 months, with no significant difference observed between the two groups (Laparoscopic: 12.4 ± 5.8; Open: 13.1 ± 6.3, p = 0.51). The distribution of patients according to the type of fistula is presented in Table 1. Congenital Fistula: Laparoscopic: 5 (4.3%), Open: 3 (2.6%), Total: 8 (3.5%) (p = 0.62) and Acquired Fistula: Predominantly represented, Laparoscopic: 110 (95.7%), Open: 112 (97.4%) (p =0.62). Postoperative complications were found to be lower in the laparoscopic group (10 [8.7%]) than in the open group (20 [17.4%]) (p = 0.03) for the cohort with infectious complications. However, no significant difference was observed (p = 0.21), with the laparoscopic group experiencing 5 (4.3%) cases compared to the open group's 10 (8.7%). Reoperation was necessary in: No reoperations were recorded in the Laparoscopic group, compared to two (1.7%) in the Open group (p = 0.50). The conclusions drawn from this study are as follows: The results suggest that patient-specific surgical approaches can increase closure rates and decrease complications associated with VVFs. The findings underscore the significance of integrating pre-operative imaging and collaborative surgical approaches in optimizing patient outcomes. Further studies may be warranted to understand long-term recovery and psychosocial consequences on the patient for whom the vesicovaginal fistula was treated