{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:16:10Z","timestamp":1792282570141,"version":"4.4.0"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Several surgical approaches are available for the repair of complex vesico\u2010vaginal fistulas; however, robust clinical evidence and standardization of techniques are lacking. Complex vesico\u2010vaginal fistula is defined as either a recurrent fistula following primary surgical repair or a fistula related to prior pelvic surgery and\/or radiotherapy. The aim of this study was to describe a step\u2010by\u2010step combined vaginal and laparoscopic technique and to assess its feasibility, safety, and efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>A retrospective study was performed between 2016 and 2023, involving patients diagnosed with complex vesico\u2010vaginal fistulas. Clinical, perioperative, and postoperative data were collected. The surgical technique was standardized, described, and executed by an experienced surgeon in each case. Postoperative urogynecological follow\u2010up was scheduled at one month, 3 months, 6\u2009months, and one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 20 patients were included in the study. Fifteen patients developed vesico\u2010vaginal fistulas after total hysterectomy, four after radical hysterectomy combined with radiotherapy, and one following a cesarean section. Four patients had a prior diagnosis of gynecological cancer, four had received pelvic radiotherapy, and two had undergone previous chemotherapy. Twenty\u2010five percent of the patients exhibited VVF in the trigone area. The median operative time was 317\u2009min (ranging from 250 to 508\u2009min). One minor postoperative complication occurred, and there was no conversion to laparotomy. All repairs were watertight. The median length of hospital stay was 4\u2009days (ranging from 2 to 6\u2009days). No recurrences were observed during the follow\u2010up period, lasting 42\u2009months on average.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated the feasibility and safety of a new surgical approach for repairing complex urogenital fistulas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70119","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T04:33:06Z","timestamp":1776400386000},"page":"1026-1031","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Step\u2010by\u2010step combined surgical approach to successfully repair complex and challenging vesico\u2010vaginal fistulas: Insights from a case series"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8257-0618","authenticated-orcid":false,"given":"Martina","family":"Arcieri","sequence":"first","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, \u201cSanta Maria della Misericordia\u201d University Hospital Azienda Sanitaria Universitaria Friuli Centrale  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7848-0329","authenticated-orcid":false,"given":"Stefano","family":"Restaino","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, \u201cSanta Maria della Misericordia\u201d University Hospital Azienda Sanitaria Universitaria Friuli Centrale  Udine Italy"},{"name":"PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health University of Sassari  Sassari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6178-2233","authenticated-orcid":false,"given":"Veronica","family":"Tius","sequence":"additional","affiliation":[{"name":"Medical Area Department (DAME), in Department of Medicine (DMED) University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lombisani","sequence":"additional","affiliation":[{"name":"Precision Gynaecological Surgery Unit Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1911-1060","authenticated-orcid":false,"given":"Davide","family":"Arrigo","sequence":"additional","affiliation":[{"name":"Department of Woman, Child and Public Health Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"},{"name":"Istituto di Ginecologia e Ostetricia Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Porto","sequence":"additional","affiliation":[{"name":"Department of Human Pathology of Adult and Childhood \u201cGaetano Barresi\u201d, Unit of Obstetrics and Gynecology University of Messina  Messina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5473-9503","authenticated-orcid":false,"given":"Giovanni","family":"Panico","sequence":"additional","affiliation":[{"name":"Department of Woman, Child and Public Health Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0858-025X","authenticated-orcid":false,"given":"Daniela","family":"Caramazza","sequence":"additional","affiliation":[{"name":"Precision Gynaecological Surgery Unit Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3774-0259","authenticated-orcid":false,"given":"Lorenzo","family":"Vacca","sequence":"additional","affiliation":[{"name":"Precision Gynaecological Surgery Unit Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2128-077X","authenticated-orcid":false,"given":"Giuseppe","family":"Campagna","sequence":"additional","affiliation":[{"name":"Precision Gynaecological Surgery Unit Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0587-8467","authenticated-orcid":false,"given":"Canio","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Human Pathology of Adult and Childhood \u201cGaetano Barresi\u201d, Unit of Obstetrics and Gynecology University of Messina  Messina Italy"},{"name":"Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology Temple University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2424-2691","authenticated-orcid":false,"given":"Giuseppe","family":"Vizzielli","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, \u201cSanta Maria della Misericordia\u201d University Hospital Azienda Sanitaria Universitaria Friuli Centrale  Udine Italy"},{"name":"Medical Area Department (DAME), in 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