# Is Endoscopic Approach Alone Adequate for the Management of Ureterovaginal Fistulas?

## TL;DR

Endoscopic DJ stenting can effectively treat small, early-detected ureterovaginal fistulas, but success is reduced in cases with large fistulas, delayed diagnosis, or comorbidities like diabetes.

## Contribution

This study provides empirical evidence on the efficacy of endoscopic DJ stenting for UVFs, identifying key predictors of treatment success.

## Key findings

- DJ stenting had a 77.4% success rate in treating UVFs.
- Early diagnosis (<4 weeks) and small fistula size (<5 mm) were associated with higher success rates.
- Late diagnosis, large fistulas, diabetes, and elevated creatinine independently predicted treatment failure.

## Abstract

Background: Most ureterovaginal fistulas (UVFs) are caused by gynecologic, urologic, or colorectal surgeries. Urine leaks, renal failure, and infections lower patients' quality of life. Minimally invasive endoscopic double-J (DJ) stenting has become popular. There is insufficient research on the effects of DJ stenting on fistula size, diagnostic timeliness, and patient comorbidities.

Objective and methods: This study examines the efficacy of endoscopic DJ stent implantation in treating UVFs and addresses aspects such as fistula size, diagnosis timing, and comorbidities. This is a five-year retrospective study (2019 to 2024) conducted in Bhopal, India, comprising 31 patients with UVF who received endoscopic DJ stenting as the main treatment. Analyses included patient demographics, clinical presentation, fistula features, treatment outcomes, and complications. Statistical analysis includes chi-square tests for categorical variables and logistic regression for risk factor assessment, with a p-value < 0.05 considered significant.

Results: DJ stenting showed a success rate of 77.4% (24/31 cases), with higher rates for early diagnosis (<4 weeks) and small fistula size (<5 mm) (p=0.038 and 0.032, respectively). Late diagnosis (>4 weeks), large fistula size (>5 mm), diabetes, and elevated creatinine (>1.2 mg/dL) were independent predictors of treatment failure in multivariate analysis. Minor issues included dysuria (16.1%, n=5) and hematuria (9.7%, n=3). One patient (3.2%) needed surgery due to a forgotten DJ stent.

Conclusion: If the UVF is minor and detected early, endoscopic DJ stenting can work. Renal failure, diabetes, larger fistulas, and delayed diagnosis reduce treatment success. Early prognostic identification and patient selection are crucial to maximize results and minimize surgery.