Clinical and Surgical Outcomes of Transvaginal and Transabdominal Approaches in Vesicovaginal Fistula Repair: A Systematic Review and Meta-Analysis
نویسندگان
1 Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
2 Health Policy and Administration Department, Universitas Airlangga, Surabaya, Indonesia
3 Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
4 Faculty of Medicine, Samratulangi University, Manado, Indonesia
5 Department Obstetrics and Gynecology, Military Naval Force Hospital dr. Ramelan, Surabaya, Indonesia
6 Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
7 Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
8 Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
doi
10.24200/jogcr.10.12.986چکیده
Background & Objective: Vesicovaginal Fistula (VVF) is repaired via Transvaginal (TV) or Transabdominal (TA) approaches. We compared clinical and surgical outcomes between these methods.Materials & Methods: Systematic searches of PubMed, ScienceDirect, Google Scholar, Europe PMC, Embase, and MEDLINE (through June 2025) identified randomized and observational studies of VVF repair.Results: Fourteen studies (n=722) were included; 362 women (50.1%; mean age 39.7±6.8 years) underwent TV repair. Common etiologies were post-hysterectomy (46%) and obstructed labor (30%). TV repair had a higher recurrence than TA (RR 1.84; 95% CI 1.07-3.18; P=0.03), while TA achieved a higher overall success rate (RR 1.08; 95% CI 1.00-1.17; P=0.04). Hospital stay was shorter with TV (MD -2.78 days; 95% CI -4.54 to -1.02; P=0.002). TV also showed shorter interval to repair (MD -1.09; 95% CI -1.77 to -0.40; P=0.002) and operative time (MD -64.1 min; 95% CI -125.3 to -2.9; P<0.001). Catheter duration favored TA (MD 2.34; 95% CI 1.70–2.97; P<0.001) and estimated blood loss was lower with TA (MD 42.6; 95% CI 3.7–81.4; P=0.03). TV had fewer minor wound infections (RR 0.28; 95% CI 0.08–1.12; P=0.05), whereas TA had lower risks of LUTS (RR 2.31; 95% CI 1.05-5.09; P=0.04) and dyspareunia (RR 4.53; 95% CI 1.76-11.68; P=0.002).Conclusion: TA repair yields higher success and lower recurrence, with shorter catheter use and less blood loss; TV repair shortens operative course and hospital stay. Approach should be individualized to balance durability with perioperative recovery and complication profiles.
