Fistula Repair

Genitourinary fistula repair is organized by the two tracts involved (bladder-vagina, ureter-vagina, urethra-vagina, vesicouterine, rectovaginal, rectourethral, urethrocutaneous, urethroperineal) and by the surgical approach that accesses them best. The recurring decisions are route (transvaginal vs. transabdominal vs. transperineal vs. transanal vs. combined), timing (immediate vs. early vs. delayed), interposition flap need (none vs. Martius vs. gracilis vs. omentum), and whether a protective diversion is required. The database below is toggled by patient anatomy because the technique sets are almost entirely distinct.

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General Principles

• Principles of Fistula RepairTract anatomy and approach selection, timing-of-repair, tension-free multilayer closure, non-overlapping suture lines, interposition flap indications (Martius / gracilis / omentum), concomitant diversion and stenting, radiation-bed considerations, and the legitimacy of permanent dual diversion in catastrophic pelvises.

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Technique Database

Female Fistula Repair

All Fistula TypesObstetricRVFUVFUrethrovaginalVUFVVF

15 of 15 techniques

Technique	Fistula Type	Notes
Transvaginal Latzko Repair	VVF	Simple, high-supratrigonal VVF closed by partial colpocleisis — excision of a vaginal cuff around the fistula with layered closure. Low-morbidity first-line option for small post-hysterectomy VVFs.
Transvaginal VVF Repair with Martius Flap	VVF	Transvaginal closure with interposed Martius labial fat-pad flap for recurrent, radiated, or complex VVFs where tissue bulk and vascularity drive the decision.
Abdominal / Robotic O'Conor VVF Repair	VVF	Transabdominal bivalve of the bladder through the fistula, excision, and layered closure with omental interposition. Preferred for high, posterior, or complex fistulas, concomitant ureteral reimplant, or failed transvaginal repair.
Uterine-Sparing Robotic O'Conor (VUF)	VUF	Modified O'Conor for vesicouterine fistula (Youssef syndrome) preserving the uterus in patients who desire fertility. Intracorporeal access to the vesicouterine pouch with hysterotomy-side closure.
Hysterectomy with Bladder Repair (VUF)	VUF	Definitive VUF repair for patients not desiring uterine preservation — hysterectomy plus multilayer bladder closure with omental interposition.
Ureteral Stent (UVF)	UVF	First-line management for early, recognized ureterovaginal fistulas per AUA algorithm — 95% resolution if stented within 2 weeks, falling sharply beyond 6 weeks.
Ureteroneocystostomy with Psoas Hitch (UVF)	UVF	Distal ureteral reimplantation with or without Boari flap for ureterovaginal fistulas that fail or are not amenable to stenting. Robotic approach with 100% success and 1-day length of stay (Kidd series).
Transvaginal RVF Repair	RVF	Transvaginal excision and multilayer closure of rectovaginal fistula. Low rectovaginal fistulas that are non-irradiated and uninflamed.
Transperineal RVF Repair with Gracilis Interposition	RVF	Transperineal repair with gracilis interposition flap for complex, radiated, or recurrent RVFs. Swindon series 91% primary and 95% radiation success.
Martius Flap Interposition (RVF)	RVF	Transperineal or transvaginal Martius labial fat-pad flap as an alternative to gracilis for select mid-low RVFs with favorable tissue planes.
Delayed Coloanal Reconstruction (GRECCAR)	RVF	Staged coloanal pull-through for radiation-induced RVF failing primary repairs. GRECCAR delayed-coloanal data support the approach.
Obstetric Fistula — Waaldijk / Goh	Obstetric	Classification-driven repair of obstructed-labour-injury-complex fistulas per Goh and Waaldijk frameworks. Fistula Foundation 87% success across 24,568 repairs.
Panzi Repair (Complex Obstetric)	Obstetric	Complex obstetric-fistula technique for extensive circumferential injury, with Capes head-to-head data favoring Goh over Panzi in most defects.
POFRI Procedure (FIGO 2025)	Obstetric	Post-obstetric fistula residual incontinence surgery per FIGO 2025 expert opinion for patients with closed fistulas but persistent SUI.
Urethrovaginal Fistula Repair	Urethrovaginal	Transvaginal multilayer closure with optional Martius interposition for urethrovaginal fistulas, often coexisting with urethral diverticulum or urethroplasty complication.

Male Fistula Repair

All Fistula TypesRectourethral FistulaRectovesical FistulaUrethrocutaneous FistulaUrethroperineal Fistula

15 of 15 techniques

Technique	Fistula Type	Notes
Transperineal Gracilis Interposition	Rectourethral Fistula	Lahey transperineal approach with gracilis interposition flap — the workhorse for irradiated RUFs. Vanni / Kaufman / Harris series 84–100% closure.
York-Mason Posterior Sagittal Transrectal Repair	Rectourethral Fistula	Prone posterior sagittal transrectal approach for non-irradiated RUF — van der Graaf 2025 post-RARP series, McKibben Wexner data, Dafnis 15-year durability.
Endorectal Advancement Flap	Rectourethral Fistula	Transanal mobilization of a full-thickness rectal flap to cover the rectal side of a small (<1.5 cm), non-irradiated RUF after fistula tract excision. Lower-morbidity option for favorable anatomy; reported success rates are highly variable (25–100%) and depend on patient selection and absence of radiation.
Transanal Minimally Invasive Repair (MITAR / TAMIS)	Rectourethral Fistula	MITAR and TAMIS platforms for low, non-irradiated RUFs with favorable access. Lower morbidity alternative to York-Mason in selected cases.
Robotic Transabdominal RUF Repair	Rectourethral Fistula	Robotic transabdominal approach for high RUF or concomitant bladder or ureteric involvement. Omental interposition where reachable.
Concurrent Urethroplasty with RUF Repair	Rectourethral Fistula	Urethroplasty performed at the same setting as fistula closure when a coexisting stricture would otherwise cause urine leakage across the repair (Khouri data).
Turnbull–Cutait Pull-Through Coloanal Anastomosis	Rectourethral Fistula	Two-stage proctectomy with delayed coloanal pull-through for severe rectal injury, radiation-damaged rectum, or failed prior RUF repair. Eliminates the diseased rectal segment when local repair is not feasible; transanal minimally invasive proctectomy with staged Turnbull–Cutait reconstruction has been reported for iatrogenic RUF.
Permanent Dual Diversion (Catastrophic RUF)	Rectourethral Fistula	Urinary and fecal diversion as a definitive endpoint for irradiated, failed, multi-operated RUFs — Martins series supports this as legitimate primary option, not a failure.
Rectovesical Fistula Repair	Rectovesical Fistula	Transabdominal approach for post-prostatectomy rectovesical fistulas above the anastomosis, with omental interposition.
Two-Layer Dartos / TVF Closure (Primary Distal)	Urethrocutaneous Fistula	Double dartos or TVF closure for primary distal urethrocutaneous fistula after hypospadias repair. Fahmy algorithm favors two-layer repair for distal primary UCF.
Tunica Vaginalis / Scrotal Flap (Proximal / Redo)	Urethrocutaneous Fistula	Tunica vaginalis or scrotal flap interposition for proximal, redo, or post-fistula-repair UCFs. Choudhury 2023 meta supports waterproofing with TVF/scrotal at 94–95% vs 73% simple closure.
Staged Diversion (Neurogenic)	Urethrocutaneous Fistula	Urinary diversion for refractory UCF in neurogenic patients — Raup series 81% diversion rate for neurogenic-bladder UCF.
Gracilis Interposition Repair (UPF)	Urethroperineal Fistula	Transperineal gracilis interposition for acquired urethroperineal fistula. Guo series 91% success with gracilis-interposition repair.
Definitive Perineal Urethrostomy	Urethroperineal Fistula	Primary perineal urethrostomy as definitive endpoint for complex UPF — Klemm 2024 long-term PROs frame this as a legitimate primary option (95% success, Fuchs data).
CUPF Repair (Cheng Differential)	Urethroperineal Fistula	Congenital urethroperineal fistula — Cheng diagnostic differentiator prevents misdiagnosis as urethral duplication or H-type RUF; repair is tract excision with layered closure.