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.