clinical and surgical outcomes of transvaginal and transabdominal approaches in vesicovaginal fistula repair: a systematic review and meta-analysis

Background & objective: vesicovaginal fistula (vvf) is repaired via transvaginal (tv) or transabdominal (ta) approaches. we compared clinical and surgical outcomes between these methods.materials & methods: systematic searches of pubmed, sciencedirect, google scholar, europe pmc, embase, and medline (through june 2025) identified randomized and observational studies of vvf repair.results: fourteen studies (n=722) were included; 362 women (50.1%; mean age 39.7±6.8 years) underwent tv repair. common etiologies were post-hysterectomy (46%) and obstructed labor (30%). tv repair had a higher recurrence than ta (rr 1.84; 95% ci 1.07-3.18; p=0.03), while ta achieved a higher overall success rate (rr 1.08; 95% ci 1.00-1.17; p=0.04). hospital stay was shorter with tv (md -2.78 days; 95% ci -4.54 to -1.02; p=0.002). tv also showed shorter interval to repair (md -1.09; 95% ci -1.77 to -0.40; p=0.002) and operative time (md -64.1 min; 95% ci -125.3 to -2.9; p<0.001). catheter duration favored ta (md 2.34; 95% ci 1.70–2.97; p<0.001) and estimated blood loss was lower with ta (md 42.6; 95% ci 3.7–81.4; p=0.03). tv had fewer minor wound infections (rr 0.28; 95% ci 0.08–1.12; p=0.05), whereas ta had lower risks of luts (rr 2.31; 95% ci 1.05-5.09; p=0.04) and dyspareunia (rr 4.53; 95% ci 1.76-11.68; p=0.002).conclusion: ta repair yields higher success and lower recurrence, with shorter catheter use and less blood loss; tv repair shortens operative course and hospital stay. approach should be individualized to balance durability with perioperative recovery and complication profiles.