To investigate the surgical timing and clinical efficacy of trans-bladder repair of vesicovaginal fistulae.

Clinical data of 21 patients who were diagnosed with vesicovaginal fistula in Lingnan hospital, the Third Affiliated Hospital of Sun Yat-sen University and local hospitals from January 2012 to April 2018 were retrospectively analyzed. The patients were aged 24-66 years. The course of disease was ranged from 3 months to 30 years. All patients underwent cystoscopy. Sixteen cases had a single fistula, two fistulae in 4 cases and three fistulae in 1 case. The fistulae were 0.3-1.5 cm in size. The fistulae were located adjacent to the ureteral orifice in 6 patients, posterior wall of the bladder floor in 9 cases and posterior interureteric ridge in 6 patients.

All 21 patients underwent the repair of vesicovaginal fistulae, including 16 cases via the bladder route, 4 via the bladder combined with abdominal route, and 1 via the bladder combined with vaginal route. One endometrial cancer patient experienced mild urine leakage at two months after the repair operation via the bladder combined with vaginal approach caused by adjuvant radiotherapy. The remaining 20 cases successfully completed the repair surgery. No urine leakage, ureteral injury or alternative complications occurred during postoperative 1-65 month follow-up.

Trans-bladder repair of vesicovaginal fistulae is an efficacious and safe treatment of complex fistulae. Intraoperatively, abdominal or vaginal repair can be integrated according to the status of fistulae to enhance the clinical efficacy and safety.