Objective:

To identify and synthesize surgical and patient-related determinants of recurrence after vesicovaginal fistula repair.

Approach:

Key Findings:

• Fistula size greater than 2-3cm is a predictor of recurrence (OR: 1.0-6.0).
• Severe peri-fistula fibrosis increases recurrence risk (OR: 2.7 to 12.0).
• Involvement of the urethra and/or bladder neck is associated with varying recurrence odds (OR: 0.4 to 9.0).
• Multiple fistulas significantly increase recurrence risk (OR: 4.0 to 8.0).
• Protective factors include early intervention, surgery in specialist centers, and use of interposition flaps.

Interpretation:

Validated predictive factors for preoperative risk stratification may enhance surgical outcomes for VVF repair.

Limitations:

• Heterogeneity in study design, etiology, and surgical techniques limited meta-analysis.
• Most studies had a low to moderate risk of bias.

Conclusion:

Further prospective research and development of predictive models are needed to optimize surgical techniques and outcomes.

Attribution Notice

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