Transvaginal Repair of Supratrigonal, Juxtacervical, Vault, and Apical Vesicovaginal Fistulae: A Systematic Review and Meta-Analysis.

Abstract

Objective: This systematic review and meta-analysis assesses the success rate, surgical and quality of life outcomes, and complications of vaginal repair of supratrigonal, jux tacervical, vault, and apical vesicovaginal fistulae (VVF) as a group. Methods: PubMed, Embase, and Cochrane were searched for studies published from January 2003 to August 2023. Sixteen (n = 612) and 15 (n = 568) studies were included in the review and meta-analysis, respectively. Risk of bias assessment was done using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Four studies (n = 196) reported sexual health outcomes. Comprehensive meta-analysis software (trial version 3) was used for quantitative synthesis. Results: The success rate (95% CI) of vaginal repair of this specific group of VVF using a random effects model was 86.3% (76.5%-92.4%). I2 was 73.72% with a Q-value of 53.27. The mean age of patients was 43.7 years. Follow-up duration ranged from 1 to 84 months. There were no major intraoperative complications except for 1 inadvertent bowel injury. Postoperative complications included Urinary tract infections (n = 5), stress incontinence (n = 2), urge incontinence (n = 2), hematuria (n = 3), and vaginal bleeding (n = 3). One hundred eighty-four patients reported no sexual dysfunction, while 6 patients had a Female Sexual Function Index score ! 26.5. Conclusion: The studies included in this meta-analysis are largely heterogeneous and retrospective, which is a limitation of this meta-analysis. Despite this, the results of this meta-analysis confirm successful correction of most of the VVF included in this review by the transvaginal route. While preferences for a given surgical approach may vary based on the number and size of the VVF or vaginal capacity, these factors need to be studied prospectively to understand their role in deciding the route of repair.