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Vesicovaginal fistula: A narrative review
*Corresponding author: Arunkumar Ramjibhai Vaghela, Department of Pharmacology, Shree Aryatej Institute of Pharmacy, Morbi, Gujarat, India drxavaghela@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Vaghela AR. Vesicovaginal fistula - A narrative review. South Asian J Health Sci. 2025;2:75-82. doi: 10.25259/SAJHS_41_2025.
Abstract
Vesicovaginal Fistula (VVF) is an abnormal connection between the bladder and vagina that results in persistent urinary leakage and significant physical, psychological, and social suffering. In high-resource environments, VVF is primarily iatrogenic, frequently occurring after pelvic surgeries such as hysterectomy, whereas in low-resource areas, it is mainly caused by prolonged obstructed labour, indicating insufficient obstetric care. Diagnosis depends on pelvic examination, dye tests, cystoscopy, and suitable imaging modalities. Small, recent fistulae may resolve with conservative catheter drainage; however, the majority necessitate surgical intervention, which can be performed through transvaginal, transabdominal, or laparoscopic approaches. or robotic methods. A multilayered, tension-free closure with optional tissue interposition is necessary for successful repair. Improved intrapartum care, expert surgical technique, and prompt management of obstructed labour are all part of prevention, which is still crucial. Improving individualised risk assessment, improving minimally invasive repairs, and addressing global disparities that sustain the burden of obstetric fistula are future priorities.
Keywords
Low-resource settings
Obstetric fistula
Pharmacological management
Surgical repair
Vesicovaginal fistula
INTRODUCTION
Vesicovaginal fistula (VVF), which is defined as an abnormal epithelial-lined communication between the urinary bladder and the vagina that results in the continuous and involuntary leakage of urine through the vaginal canal, is one of the most distressing and crippling urogenital complications affecting women worldwide [Figure 1]. Despite being historically common, particularly in areas with limited access to obstetric care, VVF continues to be a significant global health issue that reflects disparities in maternal healthcare systems, social determinants of health, and surgical safety standards.[1]
- Vesicovaginal fistula
Ancient Egyptian and Greek medical texts contain some of the earliest descriptions of VVF, which has been documented for centuries. Nowadays, the cause of VVFs varies greatly by region. In low-resource settings, obstructed labour and prolonged, unrelieved pressure on pelvic tissues continue to be the most common causes, while in developed nations, iatrogenic injuries following gynaecological or pelvic surgeries, such as hysterectomy, account for the majority of VVFs. Whatever the cause, VVF has a significant physiological impact. In addition to the psychological effects—social isolation, depression, marital discord, and loss of dignity—the persistent leakage of urine causes excoriation of the perineal skin, infections, and an unpleasant odour.[2]
Maternal health disparities are most strongly associated with the global burden of VVF. Over 2 million women are thought to have untreated obstetric fistulas, many of which include VVF, especially in South Asia and sub-Saharan Africa. In the absence of emergency obstetric interventions, these women frequently endure prolonged obstructed labour, which results in ischaemic necrosis of pelvic tissues. On the other hand, obstetric fistulas have significantly decreased in high-income countries due to better obstetric care; however, complicated pelvic surgeries, radiation therapy for cancer, minimally invasive procedures, and pelvic floor mesh complications have become major contributors.[2]
VVF is the biological consequence of direct surgical trauma, necrosis, or tissue ischaemia. The defect can range greatly in size, shape, and anatomical extent, from tiny pinpoint openings to large, intricate fistulas involving the ureters or the urethra. Spontaneous closure is uncommon without corrective surgery, and prolonged leakage can cause kidney damage, ureteric obstruction, secondary infections, and a major decline in quality of life.[3]
Over time, VVF management has changed dramatically. The cornerstone of treatment is still surgical repair, which can be done transvaginally, transabdominally[4], laparoscopically, or with robotic assistance, though conservative methods like bladder drainage may help choose early or small fistulas. Careful patient selection, repair timing, local tissue health optimisation, and surgeon skill are all critical to surgical success. Recent advances in minimally invasive technology, biomaterials, tissue flaps, and reconstructive techniques have improved results and decreased recurrence rates. Pharmacological treatment is supportive and mainly deals with tissue healing, pain, inflammation, and infection.[3]
Prevention is still the best course of action, despite advancements. The incidence of VVF can be significantly decreased by increasing access to safe childbirth services, trained birth attendants, emergency obstetric care, and safer pelvic surgery techniques. In addition, community awareness campaigns, surgeon education, and public health initiatives are crucial in lowering avoidable cases.
Epidemiology of vesicovaginal fistula
Significant disparities in maternal care access, surgical safety, and health system infrastructure are reflected in the epidemiology of VVF, which continues to be a major global health concern. Although the overall prevalence has declined in countries with advanced healthcare systems, VVF still disproportionately affects women in low- and middle-income areas.[5]
Global burden
An estimated 2–3 million women worldwide suffer from untreated urogenital and obstetric fistulas, with vesicovaginal communication accounting for a significant portion of these cases. Prolonged obstructed labour and inadequate maternal health services continue to be major contributors to the highest burden, which is reported in parts of the Middle East, South Asia, and sub-Saharan Africa. Some of the nations with the highest caseloads are Ethiopia, Nigeria, Uganda, Sudan, Bangladesh, and Nepal.[5]
Regional variability
Due to regional variations in medical infrastructure, socioeconomic circumstances, and cultural customs, the incidence of VVF varies significantly. In low-resource countries, VVF remains a major public health problem with an incidence of 1.5 to 7.5 cases per 1,000 deliveries. The overwhelming majority—about 80–95%—arises from obstetric causes, particularly prolonged obstructed labour and delayed access to emergency caesarean sections. High-income nations, on the other hand, report a significantly lower incidence of 0.3–2 cases per 1,000 gynaecological surgeries. Here, the most common causes are radiation therapy, urological procedures, pelvic oncological surgeries, and iatrogenic injuries after hysterectomy. These stark differences highlight disparities in women’s healthcare access and quality.[5]
Cause-specific epidemiology
Depending on the underlying aetiology, VVF patterns vary. Up to 90% of VVFs in developing nations are caused by obstetric causes, which continue to be the leading cause. Fistula formation usually happens three to ten days after delivery as a result of prolonged obstructed labour, which causes pressure-induced ischaemia and subsequent tissue necrosis. About 75% of cases in developed countries are caused by surgical or iatrogenic procedures, most frequently following gynaecological procedures like laparoscopic, vaginal, or abdominal hysterectomy. In particular, laparoscopic procedures have been increasingly linked to fistulas caused by thermal injuries. Another important subset is radiation-associated VVF, which affects 1–5% of women receiving pelvic radiation therapy for endometrial, bladder, or cervical cancer. Due to radiation-induced fibrosis and inadequate tissue vascularity, these fistulas are typically complicated.[5]
Age distribution
Different regions exhibit different patterns in age-related epidemiology. Young women between the ages of 15 and 30 are frequently affected by VVF in low-income nations, especially first-time mothers who are more susceptible to obstructed labour because of their smaller pelvic dimensions. On the other hand, in high-income countries, VVF is more common in older women between the ages of 40 and 60. This is because gynaecologic surgeries and cancer treatments are more common in this age group. These differences show how obstetric patterns, reproductive age, surgical exposure, and access to healthcare affect the distribution of VVF.[5]
Social and cultural factors
Underlying sociocultural factors significantly influence the burden of VVF. In underdeveloped areas, teenage pregnancies and early marriage raise the risk of obstructed labour. The length of labour and the risk of tissue damage are further increased by inadequate transportation, delayed referrals, and a shortage of trained birth attendants. Women are at a very high risk of developing VVF due to gender inequality, poverty, illiteracy, and restricted autonomy over reproductive choices. These elements not only increase the prevalence of the condition but also impede prompt treatment, thereby sustaining social isolation and stigma cycles.[6]
Hospital- and procedure-based incidence
Hysterectomy is the most common cause of iatrogenic VVF globally, according to hospital-based epidemiological data. The risk varies depending on the surgical technique; it ranges from 0.1–1% for abdominal hysterectomy, 0.2–0.8% for vaginal hysterectomy, and 0.3–1.8% for laparoscopic hysterectomy, which is partially caused by energy-based instruments. In certain institutions, up to 5% of iatrogenic fistulas are caused by caesarean section injuries. Although they are less frequent causes, urological procedures like cystolithotomy and bladder tumour resections are still acknowledged contributors. These findings highlight the significance of postoperative monitoring, careful intraoperative technique, and surgical training.[6]
Trends over time
In areas where maternal health services have grown, epidemiological trends over the past few decades show a slow decrease in obstetric VVFs. As minimally invasive surgeries become more common and pelvic cancer treatments become more widely used, high-income nations report an increase in iatrogenic and postoperative VVFs. More precise detection and documentation have been made possible by increased awareness, better reporting systems, and the creation of specialised fistula repair centres. The impact of public health initiatives and changing healthcare systems are reflected in these shifting trends.[7]
Underreporting
VVF is still notably underreported, particularly in rural and marginalised communities, despite improved surveillance systems in some areas. Due to a lack of knowledge, access to healthcare, social rejection, and the stigma attached to incontinence, many women endure years of silent suffering. Because of this, the actual worldwide burden is probably greater than what is currently estimated. Women are frequently discouraged from seeking treatment due to cultural barriers and fear of discrimination, which results in the presentation of chronic diseases.[7]
Public health implications
In any health system, VVF is a key measure of the standard of surgical and maternal care. Systemic flaws like inadequate emergency obstetric services, a shortage of trained birth attendants, subpar surgical safety procedures, and shoddy radiotherapy quality assurance programs are the cause of persistently high rates in some areas. The urgent need for focused prevention, improved community education, investments in maternal healthcare infrastructure, and reinforcement of surgical and obstetric training programs is highlighted by these epidemiological insights. Improving women's reproductive health outcomes and lowering the global burden of VVF requires addressing these deficiencies.[7]
Aetiology of vesicovaginal fistula
1. Obstetric causes
Obstetric causes remain the most common aetiology of VVF in low-resource regions, where prolonged and obstructed labour is a major factor. During obstructed labour, the fetal head exerts continuous pressure on the bladder base and anterior vaginal wall, cutting off the blood supply and leading to ischemic necrosis. After 3–10 days, the necrotic tissues slough off, forming a fistula. Additional obstetric contributors include inappropriate or forceful use of instruments such as forceps or vacuum extractors, poorly managed caesarean sections, and uterine rupture. These conditions are most common in areas lacking skilled birth attendants and emergency obstetric care, and the risk is heightened for young primigravida with an immature pelvis.[8]
2. Iatrogenic surgical causes
The most common cause of VVF in developed healthcare systems is iatrogenic surgical injury. The most common procedure related to VVF is a hysterectomy, in which the bladder is cut, sutured, or thermally damaged due to its close proximity to the uterus. Injury risk is increased by distorted anatomy, endometriosis, and dense adhesions. Due to thermal burns that manifest days or weeks later, minimally invasive laparoscopic procedures also contribute to delayed fistulas. Other surgical causes include pelvic cancer surgeries, caesarean section injuries, urological procedures, and pelvic floor reconstructions involving mesh or sling implants that can erode into the bladder.[9]
3. Radiation-induced causes
Another major cause of VVF is radiation therapy for pelvic malignancies, especially in women receiving treatment for endometrial, bladder, or cervical cancers. Radiation impairs the ability of pelvic organs to heal, reduces vascularity, and causes progressive tissue fibrosis. These alterations weaken the walls of the bladder and vagina over time, increasing the risk of fistula formation and breakdown. Radiation-induced fistulas are frequently large, complex, and linked to significant tissue damage, making surgical repair more difficult. They may appear months or even years after treatment.[10]
4. Malignancy-related causes
When cancerous tissue invades and destroys the anatomical boundaries between the bladder and vagina, pelvic malignancies can directly result in vesicovaginal fistula. The most frequent cancer linked to VVF is cervical cancer, which is followed by bladder, vaginal, vulvar, and uterine cancers. Haematuria, persistent pelvic pain, or an unpleasant-smelling discharge may accompany these fistulas, which frequently appear late in advanced disease. Palliative rather than curative treatment may be necessary for tumour-associated fistulas, which typically indicate a poor prognosis.[10]
5. Traumatic causes
Both obstetric and non-obstetric injuries are traumatic causes of VVF. Inadequate internal examinations or improper use of instruments during childbirth can result in obstetric trauma. Penetrating injuries like gunshot or stab wounds, severe sexual violence, especially in conflict areas, and pelvic fractures from auto accidents are examples of non-obstetric trauma. These wounds may cause direct harm to the vagina and bladder, leading to the development of fistulas. In rare cases, foreign objects placed in the vagina may result in long-term pressure or chemical damage that breaks down tissue.[11]
6. Infectious causes
Although they are less frequent, infectious aetiologies can cause pelvic tissue destruction and fistulas. Severe inflammation, abscess formation, and tissue necrosis can be caused by genital tuberculosis, necrotising pelvic infections, schistosomiasis in endemic areas, and chronic pelvic inflammatory disease. These infectious processes weaken the vaginal and bladder walls over time, increasing the risk of fistula development and perforation.[12]
7. Congenital causes
Congenital vesicovaginal fistulas are incredibly uncommon and result from urogenital tract developmental abnormalities. The bladder and vagina may communicate abnormally from birth due to conditions like cloacal abnormalities, persistent urogenital sinus, or Müllerian duct malformations. These cases are typically identified in childhood when the afflicted girl continues to dribble urine despite receiving regular potty Training.[13]
8. Miscellaneous causes
VVF can also develop as a result of a number of unusual factors. Pelvic tissues can be weakened by autoimmune diseases like Crohn's disease or vasculitis, prolonged catheterisation leading to pressure necrosis, and chemical injuries from caustic substances inserted into the vagina. These processes weaken tissue integrity and blood flow, which promotes the development of fistulas. These cases demonstrate the various pathological processes that can result in VVF, despite their rarity.[13]
Pathogenesis
The occurrence of vesicovaginal fistula and the multiple causes have been briefly described in Figure 2.
- Pathogenesis of vesicovaginal fistula (VVF), UTI: Urinary tract infection.
Signs and symptoms of vesicovaginal fistula
The primary clinical symptom of VVF is persistent, involuntary urine leakage through the vagina, which frequently results in severe social embarrassment, odour, and hygiene issues. Women often report persistent wetness, necessitating frequent changes of clothes or pads because urine avoids the urethra. Prolonged leakage can cause the vulvar and perineal skin to become irritated and excoriated, which can cause burning, itching, ulceration, or secondary bacterial or fungal infections. Urine contamination of the vaginal canal can lead to recurrent UTIs in certain patients. Dysuria, pelvic pain, or suprapubic discomfort are possible extra symptoms, particularly if the fistula is linked to inflammation or previous surgical trauma. Women may only notice urine leakage during physical activity, coughing, or when the bladder is full if the fistula is small or high. Reduced bladder capacity from large fistulas may lead to nocturia, urgency, or frequent urination. If the surrounding reproductive structures are impacted, women with obstetric or radiation-induced fistulas may also experience dyspareunia, vaginal scarring, and occasionally irregular menstruation. All things considered, the symptoms significantly lower quality of life, emotional stability, sexual health, and social engagement, frequently leading women to seek medical care.[14]
DIAGNOSIS
The diagnosis method, description/purpose, and key findings are illustrated in Table 1. [15]
| Diagnostic method | Description / Purpose | Key findings |
|---|---|---|
| Clinical history | Evaluates onset of symptoms after childbirth, surgery, or trauma. | Continuous leakage of urine per vagina. |
| Pelvic examination | Visual inspection of vaginal walls, tissue health, and fistula location. | Visible opening, tissue fibrosis, vaginal scarring. |
| Methylene blue dye test | Bladder filled with blue dye to check for vaginal leakage. | Blue-stained fluid in the vagina confirms VVF. |
| Three-swab/tampon test | Tampons are placed in the vagina; dye is instilled into the bladder. | Upper swab staining indicates fistula location. |
| Cystoscopy | Endoscopic visualisation of the bladder interior. | Direct view of fistula tract, size, and number. |
| Ultrasound | Non-invasive imaging for complex fistulas. | The fluid tract or communication between the bladder and the vagina. |
| CT urography | Cross-sectional imaging with contrast. | Contrast leakage from bladder to vaginal cavity; complex anatomy assessment. |
| MRI pelvis | Detailed soft-tissue evaluation. | Clear visualisation of the fistula tract and surrounding tissue damage. |
| Voiding cystourethrography | X-ray taken during voiding after contrast instillation. | Contrast leakage outlines the fistula tract. |
| Urodynamic studies | Performed when urinary incontinence persists or the diagnosis is unclear. | Distinguishes VVF from stress/urge incontinence. |
CT: Computed tomography, MRI: Magnetic resonance imaging, VVF: Vasicovaginal fistula
TREATMENT
Future treatment of VVF, along with its advantages and limitations, is shown in Table 2.[16,17]
| Treatment category | Specific interventions/medicine names | Advantages | Limitations |
|---|---|---|---|
| Conservative management | • Continuous bladder drainage (Foley catheter 14-18 fr for 2-6 weeks) | Non-invasive; may allow closure of small fresh fistulas | Very low success in chronic or large fistulas |
| Pharmacological therapy | Antibiotics (UTI control): •Ciprofloxacin 500 mg bid •Nitrofurantoin 100 mg bid •Cefixime 200 mg bid anti-inflammatory drugs: •Ibuprofen 400 mg tid •Diclofenac 50 mg bid anticholinergics (reduce bladder spasms): •Oxybutynin 5 mg tid •Tolterodine 2 mg bid •Solifenacin 5-10 mg od topical oestragen (healing): •Estradiol vaginal cream 0.5 mg daily or alternate days nutritional support: •Vitamin C 500 mg bid •Zinc 50 mg OD •Protein-rich diet |
Improves tissue healing, reduces inflammation, controls bladder spasms, and prevents UTI | Supportive only; cannot close established fistulas |
| Transvaginal surgical repair | •Latzko partial colpocleisis •Flap-splitting repair •Martius flap interposition |
Less bleeding; shorter recovery; high success | Not for high or complex fistulas |
| Transabdominal surgical repair | •Open fistula repair •Omental or peritoneal interposition flaps |
Good access for high fistulas | More invasive; longer hospitalisation |
| Laparoscopic repair | • Laparoscopic sutured closure with omental flap | Minimal pain, faster healing, smaller scars | Requires advanced expertise |
| Robotic-assisted repair | • Robotic suturing with tissue interposition | Highest precision; best visualisation | High cost; limited availability |
| Management of radiation-induced VVF |
•Delayed repair (3-6 months) •Gracilis muscle flap •Omental flap •Bladder drainage 2-3 weeks |
Provides well-vascularised tissue to support healing | Very difficult due to radiation-damaged tissue |
| Postoperative care | Antibiotics: ceftriaxone, ciprofloxacin, Nitrofurantoin Analgesics: Paracetamol, Ibuprofen • Avoid sexual intercourse 6-8 weeks |
Prevents infection and recurrence | Requires strict patient compliance |
UTI: Urinary tract infection, OD: Once daily
Advances in regenerative medicine
Future VVF treatments are moving away from merely closing the defect and towards regenerative methods that seek to restore normal tissue architecture. With researchers creating bioengineered grafts, biodegradable scaffolds, and matrix-based patches intended to encourage re-epithelialisation and collagen remodelling, tissue engineering techniques are at the forefront of this shift. Patients with complicated or radiation-induced fistulas, where native tissue quality is low and conventional repairs frequently fail, stand to benefit most from these advancements.[18]
Stem cell–based therapies
One of the most promising approaches to managing VVF in the future is stem cell therapy. It has been shown that mesenchymal stem cells (MSCs) derived from bone marrow, adipose tissue, or amniotic fluid can accelerate tissue regeneration, improve angiogenesis, and control inflammation. According to experimental research, patients with recurrent or chronic fistulas may benefit greatly from MSCs administered via scaffold-based systems or injectable gels. This method may eventually provide a minimally invasive treatment for fistulas that are currently thought to be difficult to operate on.[19]
Role of platelet-rich plasma (PRP) and growth factors
Using concentrated growth factors and platelet-rich plasma (PRP) to improve local tissue vascularity and promote defect closure is another cutting-edge technique. Bioactive molecules found in PRP promote neovascularisation, fibroblast proliferation, and epithelial healing. Early clinical findings suggest that PRP may shorten healing times and improve success rates for small or persistent fistulas when used either on its own or in conjunction with conservative treatment or surgical repair. As more clinical data become available, this modality is anticipated to undergo additional refinement.[20]
Technological advances in surgical repair
The development of minimally invasive technology has a significant impact on the future of surgical repair for VVF. In comparison to traditional laparoscopic techniques, robotic-assisted surgery is expected to become more and more prevalent due to its superior visualisation, increased dexterity, and improved precision. To improve tissue handling and lower recurrence, future robotic platforms might incorporate microsurgical instruments, real-time perfusion imaging, and AI-guided suturing algorithms. Indocyanine green (ICG) fluorescence imaging is one technique that is becoming more and more popular for intraoperative tissue vascularity assessment, which enables better flap selection and better results.[21]
Emerging biomaterials, 3D printing, and gene-based therapies
Another important area of development is 3D-printed patient-specific implants and next-generation biomaterials. Based on imaging data, customised biodegradable plugs may help seal complicated fistulas more precisely and with fewer complications. Simultaneously, the goal of early gene-based therapy research is to improve collagen synthesis or modify inflammatory pathways to support strong tissue healing. Together, these upcoming developments aim to integrate biological regeneration with technological accuracy, eventually making VVF treatment a more efficient, customised, and minimally invasive therapeutic area.[22]
Prevention of VVF
The main goals of VVF prevention are to enhance maternal healthcare, guarantee safe surgical procedures, and address risk factors that jeopardise the integrity of pelvic tissue. Timely management of obstructed labour, which continues to be the primary cause of obstetric fistulas, is the most crucial preventive measure in low-resource settings. This entails ensuring that all women have access to trained birth attendants, using partographs on a regular basis, and having emergency obstetric care available, including timely caesarean sections when labour becomes difficult. The risk of obstructed labour is also decreased by strengthening prenatal care, enhancing nutrition, and avoiding teenage pregnancy. Prevention relies on careful surgical technique during gynaecological procedures like hysterectomy, caesarean section, or pelvic tumour surgeries in high-income settings where the majority of VVF cases are iatrogenic. To prevent tissue devascularisation, surgeons must make sure that ureters and bladders are clearly identified, that dissection is done carefully, and that excessive cautery is avoided.[23]
By employing precise radiation dosing, cutting-edge methods like IMRT (Intensity-Modulated Radiation Therapy), and careful monitoring for early tissue damage detection, prevention also includes reducing complications following pelvic radiation therapy. Risk is further decreased by avoiding needless vaginal instrumentation, using aseptic procedures, and avoiding postoperative infections. Before undergoing pelvic surgery, women with menopause-related vaginal atrophy may benefit from topical oestrogen therapy to increase tissue strength. Maintaining proper bladder drainage and refraining from early sexual activity are examples of postoperative care that can help prevent surgical repairs from breaking down and creating fistulas. Global strategies to lower the incidence of VVF include training gynaecologic surgeons, enhancing access to healthcare, and educating the community. In order to effectively address both obstetric and iatrogenic causes, prevention ultimately necessitates a combination of safe surgical techniques, improved public health systems, and high-quality obstetric care.[24]
CONCLUSION
In this review , we have discussed briefly the etiologies and clinical issues related to vesicovaginal fistula. The accurate diagnosis is very essential for appropriate management. The treatment can be multifaceted and proper selection of procedure is to be undertaken for better outcome.
Authors’ contributions:
Conceptualisation, validation, formal analysis, investigation, resources, data curation, writing – original draft preparation, writing – review & editing, visualisation.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
Patient's consent not required as there are no patients in this study.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil
References
- Wikimedia Commons. Available from: https://en.wikipedia.org/wiki/File:Vesicovaginal_Fistula.png [Last accessed 2025 Nov 20]
- [Google Scholar]
- Vaginal approach to vesicovaginal fistula. Urol Clin North Am. 2019;46:123-33. Wikipedia. Vesicovaginal fistula [Internet]
- [CrossRef] [PubMed] [Google Scholar]
- Vesicovaginal fistulas: Prevalence, impact, and management challenges. Medicina (Kaunas). 2023;59:1947.
- [CrossRef] [PubMed] [Google Scholar]
- Clinical relevance and treatment outcomes of vesicovaginal fistula after obstetric and gynecologic surgery. Taiwan J Obstet Gynecol. 2019;58:111-16.
- [CrossRef] [PubMed] [Google Scholar]
- Vesicovaginal fistula in Tunisia: Epidemiology and risk factors of treatment failure. Prog Urol. 2021;31:1175-81.
- [CrossRef] [PubMed] [Google Scholar]
- Evaluation of etiology, characteristics, and treatment of patients with vesicovaginal fistula observed in rural Africa. J Gynecol Obstet Hum Reprod. 2021;50:101879.
- [CrossRef] [PubMed] [Google Scholar]
- Vesicovaginal fistulas: Diagnosis and surgical management. Urologe A. 2020;59:432-41.
- [CrossRef] [PubMed] [Google Scholar]
- Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute's perspective. Urologia. 2024;91:243-8.
- [CrossRef] [PubMed] [Google Scholar]
- Update on vesicovaginal fistula: A systematic review. Arab J Urol. 2019;17:61-8.
- [CrossRef] [PubMed] [Google Scholar]
- Knowledge of causes of VVF and discrimination suffered by patients in Ebonyi State, Nigeria. Soc Work Public Health. 2014;29:417-27.
- [CrossRef] [PubMed] [Google Scholar]
- Vesicovaginal fistula: Diagnosis and management. Indian J Surg. 2014;76:131-6.
- [CrossRef] [PubMed] [Google Scholar]
- A new conservative treatment approach to vesicovaginal fistula: Case report and mini-review. Aktuelle Urol. 2023;54:391-4.
- [CrossRef] [PubMed] [Google Scholar]
- State of the art for treatment of vesicovaginal fistula. Curr Urol Rep. 2017;18:60.
- [CrossRef] [PubMed] [Google Scholar]
- Preclinical evaluation of a regenerative immiscible bioglue for vesico-vaginal fistula. Acta Biomater. 2021;125:183-96.
- [CrossRef] [PubMed] [Google Scholar]
- Mesenchymal stem cell transplantation for perianal fistulas: Systematic review and meta-analysis. Stem Cell Res Ther. 2023;14:103.
- [CrossRef] [PubMed] [Google Scholar]
- Platelet-rich plasma: growth factors and proand anti-inflammatory properties. J Periodontol. 2007;78:661-9.
- [CrossRef] [PubMed] [Google Scholar]
- Transvaginal repair of apical vesicovaginal fistula via V-NOTES: Modified technique and outcomes. Sci Rep. 2024;14:31095.
- [CrossRef] [PubMed] [Google Scholar]
- Platelet-rich plasma: Overview of bioactive components. Open Med (Wars). 2016;11:242-7.
- [CrossRef] [PubMed] [Google Scholar]
- Prevention and cure of post-VVF repair incontinence by insertion of skin graft. Pelviperineology. 2017;36:11-12.
- [Google Scholar]
- Prevention of development of vesicovaginal fistula. Surg Gynecol Obstet. 1988;166:409-12.
- [Google Scholar]
