Long-Term Outcomes of Laparoscopic vs Open Vesicovaginal Fistula Repair

Abstract Introduction: Vesicovaginal fistula (VVF) is a debilitating condition that can lead to urinary incontinence and impaired quality of life. Laparoscopic repair has emerged as a minimally invasive alternative to traditional approaches, but its impact on postoperative continence remains unclear. This study evaluates the one-year outcomes of incontinence in patients undergoing laparoscopic versus non-laparoscopic VVF repair. Methods: A retrospective cohort study was conducted on 768 propensity-matched patients who underwent VVF repair, with 384 receiving laparoscopic repair and 384 undergoing non-laparoscopic repair. Groups were matched by age and race. Risk analysis, Kaplan-Meier survival analysis, and t-tests were performed to compare incontinence rates, time-to-incontinence, and severity between cohorts. Results: Patients in the laparoscopic group had a significantly lower incontinence rate (3.6%) compared to the non-laparoscopic group (10.2%, p = 0.000). The risk ratio (0.359) and odds ratio (0.335) indicated a substantial reduction in incontinence risk with laparoscopic repair. Kaplan Meier analysis showed a significantly higher continence survival probability (96.1% vs. 88.98%, p = 0.000). The hazard ratio (0.353) suggested a 65% lower risk of incontinence over time, though proportionality testing was non-significant (p = 0.466). Incontinence severity was also significantly lower in the laparoscopic group (p = 0.007). Conclusion: Laparoscopic VVF repair is associated with a significantly lower risk and severity of incontinence, with prolonged continence survival. These findings suggest that laparoscopic repair should be considered the preferred approach when feasible. Further studies are needed to assess long-term outcomes and patient quality of life.