Learning Curve of Transvaginal Closure of Supratrigonal Vesicovaginal Fistulas

Abstract

Introduction and Hypothesis: Vesicovaginal fistula (VVF) is a common genitourinary fistula, and most cases are treated by surgical repair. The deeper location of supratrigonal vesicovaginal fistulas requires specialized training and expertise to be successfully performed transvaginally. To determine the learning curve of transvaginal closure of supratrigonal VVF, which was performed by a single surgeon who had experienced only transabdominal or transvesical repair. Methods: All VVF cases without other fistulas who underwent a transvaginal approach at our institute between November 2015 and April 2023 were retrospectively reviewed. Success was defined as no urine leak via the vagina by patient report and vaginal examination at the last follow-up. Results: A total of 40 transvaginal closures in 35 VVF patients were analyzed. The average follow-up time was 2.6 ± 2.3 years, providing sufficient time to assess long-term surgical outcomes and the progression of the learning curve. The success rate after the first surgery was 82.9% (29 of 35 VVF patients), and the overall success rate was 97.5%. The success rate was significantly higher in cases 20 to 40 than in cases 1 to 10 (p = 0.018). There were no perioperative complications, including bleeding requiring blood transfusion and reoperation, and the postoperative complication was a urinary tract infection, which required intravenous antibiotics. Conclusions: Transvaginal closure of supratrigonal VVF is another approach that has many advantages, but it requires a surgeon’s experience and a learning curve. To achieve more than 80% success, a surgeon may need to perform a transvaginal approach on at least 20 of cases.