To compare the success rate and prognosis of repairing vesicovaginal fistula (VVF) via transvaginal and transvesical approaches, and to highlight a modified transvaginal repair technique which only requires single layer closure of an annular vaginal flap.

A retrospective analysis was performed on 57 consecutive patients who underwent VVF repair between 2007 and 2021. Fistula characteristics, operative factors, post-surgical complications, and outcomes were analyzed.

A total of 57 women with a median age of 50.4 (range, 27~75) years were included. The history ranged from 7 days to 8 years, with an average of 20 months. The chief complain was vaginal leakage of urine. Fifty-six (98.2%) cases of VVFs were caused by pelvic surgery, and only one resulted from difficult labour. Eleven (19.3%) cases had a history of surgical repair failure. All the 57 cases of surgery were smoothly completed. Among them, 17 patients underwent transvaginal repair, whereas 40 (70.2%) women had transvesical repair. Transvaginal approach had a significantly shorter operative time, less intraoperative blood loss, reduced postoperative hospital stay, less hospitalization cost, and lower minor complication rate than the transvesical group (P＜0.05). No serious complications occurred in either group. No cystostomy was performed in the transvaginal group, but 12 cases (30%) in the transvesical group had cystostomy. The average follow-up time was 18.5 (range, 3~48) months. The first-time success rates of transvaginal and transvesical techniques were 82.3% and 75%, respectively.

VVF repair with single layer closure of an annular vaginal flap is a technically feasible, simple, and successful approach with significantly better operative parameters and lower complications rates.