The first report of vesicovaginal fistula repair experience in Afghanistan

Vesicovaginal fistulas (VVF) are the most common type of acquired fistula, with various causes, etiologies, and management trends worldwide. We aimed to provide our first report on VVF repair experience in Afghanistan. A retrospective analysis was conducted on 46 patients who underwent VVF repair between June 2019 and June 2024. Preoperative assessment included physical examination, imaging, and cystoscopy. In cases where the diagnosis was uncertain, a patient-reported pad count (number of pads used per day) was recorded as a supplementary measure of incontinence severity. The surgical procedure involved a transabdominal transvesical approach with circumferential excision of a bladder mucosal cuff around the fistula; the fistulous tract itself was not excised. Closure was performed in two layers, and an interposition flap (peritoneal or omental) was utilized in all cases. Success was defined as the absence of urine leakage one month post-surgery. Postoperative management involved suprapubic catheter drainage for 10-15 days, antibiotics for one week, and antimuscarinics. Complications were classified using the Clavien-Dindo system. All 46 VVFs were of iatrogenic origin: 35 followed total hysterectomy and 11 followed Cesarean section. Seven fistulas were larger than 2.5 cm, and 39 were 1 cm or smaller. The mean follow-up period was 38.43 months. The surgical success rate was 100%. There were no major complications (Clavien-Dindo class ≥2); five patients had a surgical site infection, and one had a hematoma that required drainage. Transabdominal VVF repair with an interposition flap, utilizing a technique that preserves the fistulous tract, achieved a 100% success rate in this cohort. This approach is a highly effective management strategy for iatrogenic VVF in a challenging healthcare setting.