Contemporary Management of Vesicouterine Fistula

IMPORTANCE: Vesicouterine fistula (VUF) is an uncommon complication that predominantly occurs after cesarean delivery. Current evidence regarding its diagnosis and management is limited and largely derived from small retrospective studies. OBJECTIVE: The objective was to evaluate the etiological factors, clinical characteristics, diagnostic approaches, and surgical outcomes associated with VUF through a systematic review and proportional meta-analysis. STUDY DESIGN: This systematic review and proportional meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed/MEDLINE and Web of Science databases identified studies published between 2006 and 2026. Studies including at least 8 patients with VUF and reporting clinical or surgical outcomes were eligible. Pooled prevalence estimates with 95% CIs were calculated using random-effects models. RESULTS: Eight retrospective studies involving 447 patients were included. Cesarean delivery was the predominant etiological factor (pooled proportion, 95.3%), while a history of repeat cesarean delivery was identified in 78.4% of patients. Cyclic hematuria represented the most characteristic symptom. Cystoscopy was the most frequently used diagnostic modality. Surgical treatment demonstrated a pooled success rate of 97.1%, with low recurrence and postoperative complication rates of 4.3% and 5.6%, respectively. Open abdominal repair remained the most common surgical approach, although minimally invasive surgery was increasingly reported. CONCLUSIONS: Vesicouterine fistula has evolved into a predominantly cesarean delivery-related iatrogenic condition with diverse clinical manifestations. Surgical repair provides excellent outcomes with low recurrence when appropriate reconstructive principles are followed. Although the pooled surgical success rate of 97.1% is impressive, this estimate is derived entirely from retrospective observational studies, several of which are small case series. Minimally invasive surgery is a feasible option in selected patients, but comparative evidence is insufficient to determine whether it improves perioperative or long-term outcomes relative to open abdominal repair.