Transvaginal Repair of Supratrigonal, Juxtacervical, Vault, and Apical Vesicovaginal Fistulae: A Systematic Review and Meta-Analysis

TL;DR

This study reviews the effectiveness of vaginal surgery for specific bladder-vagina fistulas, finding high success rates and manageable complications.

Contribution

The paper provides a meta-analysis of transvaginal repair for a specific group of vesicovaginal fistulas, highlighting success rates and complications.

Findings

The success rate of vaginal repair for these fistulas was 86.3%.

Postoperative complications were generally minor, with no major intraoperative issues.

Sexual health outcomes were positive for most patients, with low rates of dysfunction.

Abstract

This systematic review and meta-analysis assesses the success rate, surgical and quality of life outcomes, and complications of vaginal repair of supratrigonal, juxtacervical, vault, and apical vesicovaginal fistulae (VVF) as a group.

PubMed, Embase, and Cochrane were searched for studies published from January 2003 to August 2023. Sixteen (n = 612) and 15 (n = 568) studies were included in the review and meta-analysis, respectively. Risk of bias assessment was done using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Four studies (n = 196) reported sexual health outcomes. Comprehensive meta-analysis software (trial version 3) was used for quantitative synthesis.

The success rate (95% CI) of vaginal repair of this specific group of VVF using a random effects model was 86.3% (76.5%-92.4%). I2 was 73.72% with a Q-value of 53.27. The mean age of patients was 43.7 years. Follow-up duration ranged from 1 to 84 months. There were no major intraoperative complications except for 1 inadvertent bowel injury. Postoperative complications included Urinary tract infections (n = 5), stress incontinence (n = 2), urge incontinence (n = 2), hematuria (n = 3), and vaginal bleeding (n = 3). One hundred eighty-four patients reported no sexual dysfunction, while 6 patients had a Female Sexual Function Index score ≤ 26.5.

The studies included in this meta-analysis are largely heterogeneous and retrospective, which is a limitation of this meta-analysis. Despite this, the results of this meta-analysis confirm successful correction of most of the VVF included in this review by the transvaginal route. While preferences for a given surgical approach may vary based on the number and size of the VVF or vaginal capacity, these factors need to be studied prospectively to understand their role in deciding the route of repair.

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