Predictors of recurrence after vesicovaginal fistula repair: a systematic review of surgical and patient-related factors

Background: Repair of vesicovaginal fistula (VVF) is highly effective, with primary success rates of 80-95%; however, recurrence is reported in 10-30% of cases. Factors influencing recurrence include fistula size and tissue characteristics. Methods: This systematic review identifies predictive factors for VVF recurrence by reviewing 21 studies published between 1994 and 2025 that met PRISMA criteria, and by analyzing the surgical outcomes from PubMed/MEDLINE data for various etiologies of VVF. Eligible studies reporting predictors of VVF repair were assessed for bias using the modified Newcastle-Ottawa Scale. Results: The following factors were consistently identified as predictors of VVF recurrence: fistula size greater than 2-3cm (odds ratio [OR]: 1.0-6.0), severe peri-fistula fibrosis (OR: 2.7 to 12.0), involvement of the urethra and/or bladder neck (OR: 0.4 to 9.0) and multiple fistulas (OR: 4.0 to 8.0). The following protective factors were identified: early intervention, surgery performed in a specialist center, and the use of interposition flaps. The Goh and Panzi classifications assist in the predictive risk stratification of patients. Most studies had a low to moderate risk of bias. Due to the heterogeneous nature of the studies, there was considerable variation in study design, etiology, and surgical technique; therefore, narrative synthesis rather than meta-analysis was performed. In most cases, secondary VVF repair has been documented to improve surgical outcomes; however, results for previously failed repairs remain contradictory. Conclusion: Using validated predictive factors for preoperative risk stratification may improve global VVF surgical outcomes. Closing the gap in surgical outcomes between regions and optimizing surgical techniques will require further prospective research and the development of predictive models.