{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:16:09Z","timestamp":1792282569065,"version":"4.4.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Vesicovaginal fistula (VVF) is a devastating condition for female patients. We aimed to summarize our experience in the management of VVF and the surgical outcomes at our center and propose an algorithm for clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of patients with VVF who underwent surgical treatment at our center between January 2013 and December 2024. All patients were classified into non-irradiated and irradiated groups. Medical data were analyzed, including patient demographics, fistula characteristics, vaginal width, surgical procedures, surgical outcomes, and perioperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 64 patients with VVF (20 non-irradiated and 44 irradiated). The fistula size in the irradiated group was mostly &amp;gt; 1.5\u202fcm, whereas the size was &amp;lt;1.5\u202fcm in the non-irradiated group. The vaginal width was &amp;gt; 3\u202fcm in the fistula repair group, whereas it was &amp;lt; 3\u202fcm in the urinary diversion group. For the non-irradiated group, we all performed fistula repair surgery, while only 47.7% in the irradiated group, where the remaining underwent urinary diversion (29.5%) or fistula repair + urinary diversion (22.7%). The irradiated group had a higher fistula recurrence rate than the non-irradiated group in both transvaginal (18.5% vs. 6.25%) and transabdominal (50% vs. 0%) approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We proposed an algorithm for the surgical management of VVFs based on radiation history, fistula size (&amp;gt;3\u202fcm), and vaginal width (&amp;lt;3\u202fcm). We suggest that transvaginal approach is the first option for fistula repair. For irradiated VVFs, transvaginal fistula repair with tissue interposition combined with permanent cystostomy demonstrated high success in our series, which is a valuable method.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1757810","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:52:20Z","timestamp":1778219540000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Surgical management and outcomes of vesicovaginal fistula: a 12-year experience in a tertiary center"],"prefix":"10.3389","volume":"13","author":[{"given":"Jianshu","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Urology, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Urology, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Urology, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haijun","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Urology, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3346","DOI":"10.1007\/s43032-021-00832-8","article-title":"Vesico-vaginal fistula in females in 2010-2020: a systemic review and Meta-analysis","volume":"29","author":"Shrestha","year":"2022","journal-title":"Reproduct Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1016\/s0140-6736(06)69476-2","article-title":"Obstetric vesicovaginal fistula as an international public-health problem","volume":"368","author":"Wall","year":"2006","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1007\/s00192-025-06104-2","article-title":"Analysis of various surgical approaches to Supratrigonal Vesicovaginal fistula repair: a tertiary care Centre experience","volume":"36","author":"Iyer","year":"2025","journal-title":"Int Urogynecol J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1111\/iju.15181","article-title":"Transvaginal vesicovaginal fistula closure: a retrospective study of 28 cases at a single facility in Japan","volume":"30","author":"Kurokawa","year":"2023","journal-title":"Int J Urol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s12905-023-02220-7","article-title":"The psycho-social impact of obstetric fistula and available support for women residing in Nigeria: a systematic review","volume":"23","author":"Nduka","year":"2023","journal-title":"BMC Womens Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1947","DOI":"10.3390\/medicina59111947","article-title":"Vesicovaginal fistulas: prevalence, impact, and management 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benign, primary vesicovaginal fistulas?","volume":"12","author":"Gedik","year":"2015","journal-title":"Urol J"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1007\/s00404-015-3754-6","article-title":"Surgical technique of a recurrent post-radiation vesicovaginal fistula with a small intestine graft","volume":"292","author":"Vaso","year":"2015","journal-title":"Arch Gynecol Obstet"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.1007\/s11255-025-04410-8","article-title":"Preliminary experience with minimally invasive transvaginal single-port laparoscopic vesicovaginal fistula repair: report of 10 cases","volume":"57","author":"Zeng","year":"2025","journal-title":"Int Urol Nephrol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/j.tjog.2015.10.008","article-title":"Buccal mucosal graft interposition in the treatment of recurrent vesicovaginal fistula: a report on two 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