Management of vesicovaginal fistulae following gynecologic oncology surgery: a contemporary single-center analysis of surgical outcomes and evidence-based treatment strategies

Background: The study aimed to evaluate the clinical characteristics, management strategies, and surgical outcomes of vesicovaginal fistulae following gynecologic oncology procedures, and to provide evidence-based recommendations for optimal patient care based on contemporary literature. Methods: Medical records of 10 patients diagnosed with post-surgical vesicovaginal fistulae following gynecologic oncology procedures were retrospectively analyzed. Clinical findings, contributing factors, diagnostic methods, treatment approaches, and postoperative outcomes were evaluated. Conservative management with continuous Foley catheterization was initially attempted, followed by surgical repair using abdominal, vaginal, or laparoscopic techniques when conservative treatment failed. Outcomes were assessed using standardized criteria, including anatomical success, functional outcomes, and complication rates. Results: The study cohort included 10 patients with a mean age of 51.2 years (range 42–66 years). Primary surgical procedures included radical hysterectomy for cervical cancer (n = 6), primary cytoreductive surgery for advanced ovarian cancer (n = 3), and total laparoscopic hysterectomy for benign conditions (n = 1). Initial conservative management with continuous Foley catheterization for 6–8 weeks achieved success in only 2 patients. The remaining 8 patients required surgical intervention, with successful repair achieved in all cases using various approaches: abdominal repair (n = 5), vaginal repair using the Latzko procedure (n = 2), and laparoscopic repair (n = 1). The overall surgical success rate was high with minimal complications. The mean time from primary surgery to fistula diagnosis was 16.8 days. The postoperative hospital stay averaged 6.8 days, with a catheterization duration of 14 days. Conclusions: This study demonstrates that vesicovaginal fistulae following gynecologic oncology procedures can be successfully managed with excellent outcomes by experienced specialists. Conservative management shows limited success, while surgical repair achieves high success with minimal morbidity. Standardized classification and individualized surgical approach selection are essential. These findings support centralization of complex cases to specialized centers and emphasize evidence-based management for optimal outcomes.

Vesicovaginal fistulae; Gynecologic oncology; Surgical repair; Radical hysterectomy; Minimally invasive surgery; Postoperative complications

[1] Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: an update. Indian Journal of Urology. 2007; 23: 187–191.

[2] Thompson JC, Halder GE, Jeppson PC, Alas A, Balgobin S, Dieter AA, et al. Repair of vesicovaginal fistulae: a systematic review. Obstetrics & Gynecology. 2024; 143: 229–241.

[3] Capozzi VA, Monfardini L, Scarpelli E, Barresi G, Rotondella I, De Finis A, et al. Urologic complication after laparoscopic hysterectomy in gynecology oncology: a single-center analysis and narrative review of the literature. Medicina. 2022; 58: 1869.

[4] Rotem R, Galvin D, Oprescu C, Hirsch A, O’Reilly BA, O’Sullivan OE. Quantifying the impact of bladder complications following gynecological cancer treatment: systematic review and meta-regression. Journal of Gynecologic Oncology. 2025; 36: e76.

[5] Iyer SM, Singh S, Srivastav A. Analysis of various surgical approaches to supratrigonal vesicovaginal fistula repair: a tertiary care centre experience. International Urogynecology Journal. 2025; 36: 1273–1279.

[6] Elliott SP, Fan Y, Jarosek S, Chu H, Downs L, Dusenbery K, et al. Propensity-weighted comparison of long-term risk of urinary adverse events in elderly women treated for cervical cancer. International Journal of Radiation Oncology, Biology, Physics. 2015; 92: 586–593.

[7] Arcieri M, Cuman M, Restaino S, Tius V, Cianci S, Ronsini C, et al. Exploring urinary tract injuries in gynecological surgery: current insights and future directions. Healthcare. 2025; 13: 1780.

[8] Huang J, Cheng Y, Wang B, Chao H, Xu X, Zeng T. Minimally invasive transvaginal single-port laparoscopic vesicovaginal fistula repair: a case report and the point of this technique. Frontiers in Surgery. 2024; 11: 1331476.

[9] Song X, Jiang C, Lv JW. Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes. Scientific Reports. 2024; 14: 31095.

[10] Chandna A, Mavuduru RS, Bora GS, Sharma AP, Parmar KM, Devana SK, et al. Robot-assisted repair of complex vesicovaginal fistulae: feasibility and outcomes. Urology. 2020; 144: 92–98.

[11] Kumar L, Kumar S, Agarwal S, Thakur A, Trivedi S. Laparoscopic vesicovaginal fistula repair using kumar’s knotless technique: short-term experience from a tertiary care center. Cureus. 2025; 17: e82083.

[12] Del Biondo D, Di Domenico D, Napodano G, Grillo M, Crocetto F, Barone B. Transabdominal and transvaginal repair of vesico-vaginal fistula with bovine pericardium (Tutopatch®). A double case report. Urology Case Reports. 2025; 62: 103117.

[13] Niu S, Li Y, Tu S, Niu S, Qian J, Yang F, et al. Minimally invasive complete urinary tract drainage in the treatment of vesicovaginal fistula: a case report. Experimental and Therapeutic Medicine. 2022; 24: 645.

[14] Kumar N, Sureka SK, Singh UP, Kapoor R, Rustagi S, Yadav P, et al. Vesicovaginal fistula repair by transvaginal route: comparison of resource utilisation and outcome with literature reported population matched cohort of patients operated by minimally invasive route. The Journal of Obstetrics and Gynecology of India. 2022; 72: 414–419.

[15] El-Azab AS, Abolella HA, Farouk M. Update on vesicovaginal fistula: a systematic review. Arab Journal of Urology. 2019; 17: 61–68.

[16] Rajaian S, Pragatheeswarane M, Panda A. Vesicovaginal fistula: review and recent trends. Indian Journal of Urology. 2019; 35: 250–258.

[17] Smith AV, Cabrera R, Kondo W, Zomer MT, Ferreira H. Vesico-vaginal fistula: nature and evidence-based minimally invasive surgical treatment. Surgical Technology International. 2019; 35: 189–198.

[18] Zeleke LB, Welsh A, Abeje G, Khejahei M. Proportions and determinants of successful surgical repair of obstetric fistula in low- and middle-income countries: a systematic review and meta-analysis. PLOS ONE. 2024; 19: e0303020.

[19] Che X, Ruan M, Yang Y, Xi Z, Huang Y, Wang W, et al. Comparison of sterile normal saline and 1% povidone-iodine for vaginal preparation in vesicovaginal fistula: a randomised trial. Journal of Obstetrics and Gynaecology. 2025; 45: 2439356.

[20] Wei N, Pfeuti C, Linder BJ. Contemporary genitourinary fistula management: treatment, trends, and innovations. Current Opinion in Obstetrics and Gynecology. 2025; 37: 432–437.