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O'Conor (Transabdominal Transvesical) VVF Repair

The O'Conor repair is a transabdominal transvesical approach that opens the bladder toward the fistula to expose the defect and ureteral orifices. O'Conor and Sokol published their report in 1951. Nesrallah later reported closure in all 29 selected supratrigonal iatrogenic cases, including nine with prior repair attempts, and titled the technique the gold standard for supratrigonal fistula.[1] Nesrallah's uncontrolled series had no vaginal or extravesical comparator.[1][20]

For transvaginal alternatives see Latzko Repair and Sims-Simon Multilayered Closure. For the interposition flap typically used with the O'Conor see the omental flap (and for the alternative when transvaginal repair is chosen, see Martius Flap for VVF).

Principle​

In the classic transperitoneal transvesical approach, a deliberate cystotomy exposes the fistula from within the bladder.[2][1] Wide opening of the bladder ("bivalving") provides:[2][1][3]

  • Complete intravesical visualization of the fistula tract.
  • Direct identification and protection of both ureteral orifices.
  • Direct assessment and selective excision of the fistula tract under direct vision, preserving viable tissue needed for closure.
  • Separate, layered closure of vaginal wall and bladder wall as independent tissue planes.
  • Access for concurrent ureteral reimplantation if needed.

The technique remains the traditional abdominal approach to VVF repair whether performed via open laparotomy, laparoscopy, or robotic assistance.[4][5]

Direct intravesical exposure can facilitate tract excision, but the extent of tissue removal still depends on viability and what is needed for closure. Do not sacrifice useful tissue simply to remove every area of fibrosis.[2][11]

Indications​

When transvaginal repair is precluded by fistula characteristics or patient factors:[2][6]

  • Supratrigonal fistulae that are high and difficult to expose transvaginally, a classic indication for O'Conor repair.[1][7] High location alone does not preclude vaginal repair in selected patients.[32]
  • Fistulae near the ureteral orifices requiring ureteral reimplantation (33% of the 30 fistulae in Mondet’s 28-patient series required reimplantation).[3]
  • Need for bladder augmentation.
  • Failed prior transvaginal repair. Frequently used as salvage after failed Latzko or other vaginal repairs.[8][1]
  • Concurrent abdominal pathology requiring laparotomy.
  • Narrow or stenotic vagina precluding adequate transvaginal access.[9]
  • Large or complex fistulae with extensive fibrosis.
  • Radiation-associated fistulae after cancer treatment: assess for recurrent tumor before repair.[19] If reconstruction proceeds, the EAU weakly recommends an interposition graft; omentum is an option when suitable.[19]
  • Multiple fistulae requiring comprehensive intravesical assessment.

Contraindications / poor fit​

  • Small, simple, transvaginally accessible fistulae: vaginal repair may be considered. In Shamout's retrospective mixed cohort, vaginal repair was associated with shorter operative time, less blood loss, and shorter hospital stay.[10] A Cochrane review protocol has not reported comparative outcomes.[2]
  • Patients unfit for laparotomy or general anesthesia.
  • Distal or urethral fistulae — better approached transvaginally.

Surgical Technique (Classic O'Conor)​

The classic open technique:[1][8][3][6]

1. Positioning and preparation​

  • Low dorsal lithotomy (Allen stirrups) for simultaneous abdominal and vaginal access.
  • Cystoscopy to confirm fistula location, size, and proximity to ureteral orifices. When the diagnosis is uncertain or a synchronous ureterovaginal fistula is suspected, EAU 2026 weakly recommends contrast-enhanced CT with a late excretory phase and/or MRI.[19]
  • Bilateral 5 Fr open-ended ureteral catheters placed cystoscopically for intraoperative ureteral protection.[8][11] For laparoscopic or robotic dissection, a catheter or guidewire through the fistula has been described to mark the tract.[11][31]
  • Transurethral Foley.
  • Vaginal pack or EEA sizer / probe to identify the vaginal cuff / fistula from above.

2. Abdominal incision and peritoneal entry​

  • Midline infraumbilical or Pfannenstiel incision (open).
  • Enter peritoneum; perform adhesiolysis (often extensive after prior hysterectomy).
  • Identify and mobilize the bladder dome.
  • An extraperitoneal transvesical route that avoids entering the peritoneal cavity has also been described and may be considered when extensive intraperitoneal adhesions from prior surgery or radiation are expected; the trade-off is more limited access to intraperitoneal tissue for interposition, particularly omentum. "Extraperitoneal" describes this choice of peritoneal access and is distinct from "extravesical," which describes avoiding a separate bladder access cystotomy (see Extravesical Transabdominal VVF Repair).[25]

3. Posterior cystotomy — the defining step​

  • Stay sutures on the bladder dome.
  • Sagittal (midline) cystotomy on the posterior bladder wall, extending from the dome downward toward the fistula.
  • Continue until the fistula tract is directly visualized from inside the bladder.
  • In the classic description, the bladder is essentially bivalved in the sagittal plane down to the fistula, retracting the two halves laterally for wide exposure.
  • Confirm previously placed ureteral catheters at each orifice.[1][8]

4. Fistula-tract excision​

  • Circumscribe the tract under direct vision and remove nonviable tissue or foreign material as indicated. Individualize excision, preserving viable tissue needed for a tension-free closure.
  • Excision through full-thickness bladder wall and into vaginal wall, creating separate bladder and vaginal defects.
  • Distinct from the Latzko, which does not excise the tract.[2][1]

5. Vesicovaginal-space dissection​

  • Wide dissection separates posterior bladder wall from anterior vaginal wall.
  • Mobilize sufficiently for a tension-free closure without unnecessary dissection near the ureters; the required distance depends on the defect.[6]
  • When the uterus is in situ, typically with a fistula following cesarean delivery, one description advises opening the bladder first rather than attempting to develop a plane between bladder and uterus before doing so, because blindly seeking that plane risks inadvertently entering the cervical canal.[26]

6. Vaginal-wall closure​

  • Single-layer vaginal-wall closure with interrupted 2-0 or running 3-0 absorbable sutures incorporating full-thickness vaginal wall.[30][31]
  • In some series the vaginal fistula orifice is intentionally left open to allow drainage (66% of cases in Mondet's series of 30 fistulae in 28 patients).[3]
  • An alternative description closes the vagina with interrupted 2-0 absorbable sutures, preferably in two layers, before the bladder is closed separately; this two-layer preference has not been compared with single-layer closure.[21]
  • When the uterus is in situ, closing the vaginal defect longitudinally rather than transversely has been described to avoid the tension a transverse closure would create under the intervening uterus.[26]

7. Interposition flap​

  • Select interposition according to tissue quality and repair complexity; the 2026 EAU guideline recommends a graft for radiation-associated fistula repair .[19]
  • Omental flap is the most commonly used:[2][12]
    • Mobilize the greater omentum off the transverse colon.
    • Pedicled flap based on left or right gastroepiploic artery.
    • Bring into the pelvis and suture over the vaginal closure.
    • One described fixation sequence places two absorbable sutures in the anterior vaginal wall just distal to the vaginal closure before the omentum is prepared, passes the needles through the omentum about 2 cm from its edge, and ties them with the vaginal sizer still in place to confirm the flap lies between the bladder and vaginal repairs.[24]
  • Alternatives: peritoneal flap, sigmoid epiploicae, bladder adventitia.[2][13]

8. Bladder closure​

  • Two-layer closure:[6]
    • First layer (mucosa and submucosa): running or interrupted 3-0 absorbable.
    • Second layer (detrusor and muscularis): imbricating interrupted 3-0 absorbable.
    • For a fistula that is quite large and close to a ureteral orifice, a Z-form bladder closure or V-Y plasty has been described as an option for tension-free closure.[22]
  • Closure incorporates both the fistula defect and the sagittal cystotomy.
  • Confirm watertight closure with retrograde dye fill (methylene blue or indigo carmine).[6][5]

9. Drainage​

  • Transurethral Foley and often a suprapubic catheter for continuous bladder drainage.
  • Pelvic drain (Jackson-Pratt) near the repair.
  • Maintain unobstructed bladder drainage until healing is confirmed. The 2026 EAU guideline suggests 10–14 days for simple or postsurgical fistulas and 14–21 days for complex or radiation-associated repairs ; Mondet reported a mean of 15.8 days in its series.[7][3][19]

Modified O'Conor (Dalela)​

Dalela 2006 described a modification intended to limit tissue disruption:[7]

  • A shorter cystotomy (sagittal or parasagittal) replaces full bladder bivalving and is made only long enough to see the fistula.
  • The approach is transperitoneal, without dissection of the retropubic space (space of Retzius).
  • Bladder rotation flaps replace midline closure when the defect is large.
  • Both bladder and vagina are closed with single-layer continuous interlocking sutures.
  • Vascularized tissue interposition (omental or peritoneal flap) is used in every case.

In 26 supratrigonal VVFs (17 primary, 9 recurrent), all patients were dry after 2–3 weeks of catheter drainage; mean OR time was 104 min, blood loss was described as insignificant, and 3 required ureteroneocystostomy.[7]

Other Named Variants​

"Gil-Vernet" technique. Some sources describe a variant, attributed to the name Gil-Vernet, that makes a smaller cystotomy to identify the fistula rather than extending the cystotomy to it, then circumscribes and excises the tract, mobilizes the bladder and vaginal flaps, and closes in three layers (one vaginal-wall layer, two bladder layers). This differs from the sliding posterosuperior bladder-wall flap ("vesical autoplasty") reported by Gil-Vernet and colleagues for complex fistulas in a 42-patient series, so the eponym is used inconsistently between sources. Neither variant has comparative outcome data against classic O'Conor bivalving.[23]

Single-port robotic transvesical approach. A single-port robotic technique has been described for the rare patient with a high supratrigonal VVF, poor abdominal access after prior operations, adequate bladder capacity and no requirement for postoperative radiation. Described steps include a paraumbilical incision and single-port docking, intravesical fistula identification, vaginal or transvesical tract catheterization, tract circumscision, vaginal closure, two-layer bladder closure and a leak test. This is a selected technical option; the source gives no case denominator or comparative outcome.[23]

PATIO (tract eversion) single-port transvesical repair. Kata and colleagues adapted the PATIO repair ("preserve the tract and turn it inside out") from urethrocutaneous fistula to a recurrent VVF in one 33-year-old woman whose earlier repair had included left ureteral reimplantation. The fistula was a 5 mm defect at the vaginal apex. A wire and catheter were passed through it vaginoscopically. Through a single-port robotic anterior midline cystotomy, the tract was dissected circumferentially, without puncturing it, down to its base in the vesicovaginal septum (about 5 mm of dissection around a vaginal defect of about 1 cm). After the catheter was removed, the vaginal mucosa was oversewn with running 4-0 barbed suture. The needle was then straightened and passed through the tract into the vagina, pulling the tract inside out, and was retrieved vaginoscopically and fixed at the vaginal opening to hold the eversion. Amniotic membrane was placed as a barrier, the detrusor and the bladder mucosa were closed in separate running 4-0 layers, and the cystotomy was closed in two layers of 3-0 monofilament. Operating time was 90 minutes. The catheter came out on day 10; retained suture material was removed in the office at 6 weeks, and at 6 months the fistula was healed with normal voiding and intercourse.[27]

The rationale is that the everted tract acts as a flap valve and avoids two directly opposed suture lines; the authors liken the operation to a Latzko repair performed from the bladder side, with less dissection. This is a single case, so indications, durability and comparison with standard repair remain undefined.[27]

Outcomes​

SeriesnApproachTypeSuccessKey finding
Nesrallah 1999[1]29Open O'ConorSupratrigonal iatrogenic100%Nine had prior repair attempts; the abstract’s accompanying 34% is arithmetically inconsistent with 29 patients
Dalela 2006[7]26Modified openSupratrigonal (17 primary, 9 recurrent)All dry after 2–3 weeks of catheter drainageMean OR 104 min; 3 reimplants
Mondet 2001[3]28 patients (30 fistulae)Open transvesicalMixed (47% of fistulae complex; 40% of fistulae trigonal)85% (24/28 patients)33% of fistulae required reimplantation; 38% of patients had postoperative voiding disorders
Evans 2001[12]37 overall; 29 benignOpen transabdominalBenign/malignantBenign subgroup: 10/10 with flap versus 12/19 withoutNonrandomized
Lecoanet 2023[14]22Robotic (13 transvesical, 9 extravesical)Supratrigonal + trigonalNo recurrence at median 15 monthsSmall nonrandomized comparison
Tavares 2026[15]206 across 14 studiesRobotic, both routesMixedReported recurrence 2.91%No significant route difference; heterogeneous observational data

O'Conor (Transvesical) vs Extravesical​

FeatureTransvesicalExtravesical
AccessSeparate cystotomy, bivalving or a shorter openingDissection through the vesicovaginal space without a separate access cystotomy
Bladder openingAccess cystotomy and fistula defect require closureThe fistula defect still opens into the bladder and requires closure
Ureteral protectionDirect intravesical view, with catheters/stents as indicatedCystoscopic identification and protection as indicated
SelectionUseful when intravesical exposure or associated reconstruction is neededUseful when extravesical mobilization safely exposes the defect

The 2015 review reported 95.9% transvesical and 98.0% extravesical closure across mostly case reports and series; it did not perform a conventional meta-analysis because of heterogeneity.[5] The 2026 robotic synthesis also found no significant route difference. In a prospective nonrandomized cohort of 36 women with single simple supratrigonal fistulas, extravesical versus O'Conor repair was associated with mean operative times of 117 versus 140 minutes, mean blood loss of 95 versus 210 mL, and mean stays of 3.2 versus 3.9 days.[31] At mean follow-up of 14.7 versus 12.4 months, absence of leakage was reported in 17/18 versus 15/18 (P = .153).[31] Surgeons selected the route, and mean fistula size differed (12.8 versus 19.6 mm).[5][15][31]

Omental Flap Interposition​

Omentum can provide vascularized separation between organ repairs, particularly in a compromised tissue bed. Routine use in every uncomplicated abdominal VVF remains unsupported by high-level evidence.[11][19] In a randomized trial of selected simple VVFs, abdominal closure occurred in 34/35 repairs with omental interposition and 33/34 without; mean follow-up was 39.6 months across all trial groups, and recurrent and radiation-associated fistulas were excluded.[28] A second randomized trial of open repair found no significant closure difference at one year, but changed both vaginal suturing and flap use.[29]

  • Evans's retrospective series included 29 benign fistulas: 10/10 closed with a flap versus 12/19 without. The additional two successful flap cases were malignant fistulas, so 12/12 is not the benign-group denominator. Selection and other confounding prevent a causal comparison.[12]
  • Dalela used interposition in all 26 cases; Miklos reported selected extravesical repairs without omentum. Neither one-arm experience proves whether the flap is necessary.[4][7]
  • The ERUS robotic consensus favored considering interposition, while reviews found no statistically significant closure advantage across heterogeneous reports. Individualize tissue choice, reach and harvest morbidity.[5][11]

Transabdominal vs Transvaginal​

Vaginal access is used when it provides adequate exposure and reconstruction; abdominal access may be needed for an inaccessible defect or associated ureteral or bladder reconstruction. Fistula complexity, tissue condition and surgical expertise affect selection.[6][19]

Shamout's retrospective series included 49 vaginal and 17 abdominal repairs, with 98% and 82% success respectively and better perioperative measures in the vaginal group.[10] Patient-reported follow-up studies also suggest both routes can restore function, but small responder groups and selection limit equivalence claims.[10][16][17]

Functional Outcomes and Complications​

  • Bladder function: Nesrallah reported no significant capacity loss in 29 selected cases[1], whereas Mondet reported postoperative voiding disorders in 38% of a different 28-patient cohort.[3]
  • Sexual and urinary symptoms: Studies after successful closure show persistent symptoms in some women. Panaiyadiyan enrolled 81 women with successful repairs; sexual-function outcomes used an assessed subset. Lee's FSFI response rate was only 33%.[17] The studies give no general 34% dysfunction estimate or route-specific functional comparison.[16][17]
  • Stress incontinence: One patient in each of the Nesrallah and Dalela series had residual SUI.[1][7]
  • Operative complications: Counsel about infection, bleeding, bowel or ureteral injury, ileus and wound morbidity according to the chosen exposure and associated reconstruction.[6][13]

Evolution to Minimally Invasive​

The O'Conor adapts cleanly to laparoscopic and robotic platforms:[5][9][14][15]

Laparoscopic O'Conor​

The bladder is bivalved laparoscopically, the fistula is excised and the defects are closed with intracorporeal suturing. Wong described the technique in two patients who had failed Latzko repair, and Shah reported 25 women, of whom three were converted to open surgery for dense adhesions and three of the 22 completed laparoscopically had leakage per vagina. The 2015 systematic review reported 80% to 100% success for laparoscopic and robotic VVF repair overall, across both routes.[5][8][18]

Robotic-assisted O'Conor​

Robotic VVF repair was reported from 2005.[15] The 2026 review (Tavares, 206 patients across 14 studies) combined transvesical and extravesical repairs:[15]

  • Combined mean operative time was 169.0 ± 69.5 minutes among 143 patients with reported time data (116 transvesical, 27 extravesical).[15]
  • Reported study mean blood loss ranged from 14 to 90 mL; incomplete reporting precluded a comparison by route.[15]
  • Overall complication rate 4.4% (major 0.97%).[15]
  • Recurrence was reported in 6/206 repairs (2.91%); reported study follow-up values ranged from 1.5 to 35.3 months.[15]
  • Most studies reported hospital stays less than five days.[15]

An extravesical approach avoids a separate access cystotomy and bladder bivalving, but the fistula-related bladder defect still requires closure. The route is selected for exposure and associated reconstruction.[11][14][15]

Postoperative Care​

Bladder drainage is kept unobstructed, and a second catheter and a pelvic drain are selected according to the reconstruction. Catheter and stent removal depend on the repair, ureteral reconstruction and leakage assessment.[6][11]

Wong's two-patient laparoscopic report removed ureteral catheters on days one and two and used a gravity cystogram at three weeks.[8] EAU expert guidance suggests 10–14 days of bladder drainage for simple or postsurgical and 14–21 days for complex or radiation repair, with source-specific differences summarized in fistula principles.[19]

Persistent leakage, emptying and symptoms are assessed, and dye testing, cystography or cystoscopy is chosen for the clinical question. Routine follow-up cystoscopy at six weeks to three months is not established for every uncomplicated repair. Activity and intercourse resume as tissue healing permits.

No O'Conor-specific VTE recommendation exists. This is open, laparoscopic or robotic abdominopelvic surgery, so apply the general risk framework (age, obesity, prior VTE, malignancy, prolonged operation or immobility) on the VTE Prophylaxis page rather than the cancer-surgery extended-prophylaxis regimens described there for cystectomy.

See Also​

Videos​

Robotic Transvesical Vesicovaginal Fistula Repair
AUA University (2024)
PATIO Robotic Vesicovaginal Fistula Repair
Kata A, Michelson K, Wiegand LR. Urology Video Journal 2026 (CC BY-NC 4.0): single-port transvesical tract eversion
Open source video

References​

1. Nesrallah LJ, Srougi M, Gittes RF. The O'Conor technique: the gold standard for supratrigonal vesicovaginal fistula repair. J Urol. 1999;161(2):566–568. doi:10.1016/s0022-5347(01)61951-7

2. Okada Y, Matsushita T, Hasegawa T, et al. Surgical interventions for treating vesicovaginal fistula in women. Cochrane Database Syst Rev. 2026;1:CD015413. Protocol. doi:10.1002/14651858.CD015413

3. Mondet F, Chartier-Kastler EJ, Conort P, et al. Anatomic and functional results of transperitoneal-transvesical vesicovaginal fistula repair. Urology. 2001;58(6):882–886. doi:10.1016/s0090-4295(01)01395-4

4. Miklos JR, Moore RD. Laparoscopic transperitoneal extravesical approach to vesicovaginal fistula repair without omental flap: a novel technique. Int Urogynecol J. 2015;26(3):447–448. doi:10.1007/s00192-013-2292-7

5. Miklos JR, Moore RD, Chinthakanan O. Laparoscopic and robotic-assisted vesicovaginal fistula repair: a systematic review of the literature. J Minim Invasive Gynecol. 2015;22(5):727–736. doi:10.1016/j.jmig.2015.03.001

6. McKay E, Watts K, Abraham N. Abdominal approach to vesicovaginal fistula. Urol Clin North Am. 2019;46(1):135–146. doi:10.1016/j.ucl.2018.08.011

7. Dalela D, Ranjan P, Sankhwar PL, et al. Supratrigonal VVF repair by modified O'Conor's technique: an experience of 26 cases. Eur Urol. 2006;49(3):551–556. doi:10.1016/j.eururo.2005.12.037

8. Wong C, Lam PN, Lucente VR. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2006;20(4):240–243; discussion 243. doi:10.1089/end.2006.20.240

9. Ramphal SR. Laparoscopic approach to vesicovaginal fistulae. Best Pract Res Clin Obstet Gynaecol. 2019;54:49–60. doi:10.1016/j.bpobgyn.2018.06.008

10. Shamout S, Anderson K, Baverstock R, Carlson K. Evaluation of surgical approaches for vesicovaginal fistulae repair: the case for transvaginal repair as the gold standard. Int Urogynecol J. 2021;32(9):2429–2435. doi:10.1007/s00192-021-04869-w

11. Randazzo M, Lengauer L, Rochat CH, et al. Best practices in robotic-assisted repair of vesicovaginal fistula: a consensus report from the European Association of Urology Robotic Urology Section Scientific Working Group for Reconstructive Urology. Eur Urol. 2020;78(3):432–442. doi:10.1016/j.eururo.2020.06.029

12. Evans DH, Madjar S, Politano VA, et al. Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology. 2001;57(4):670–674. doi:10.1016/s0090-4295(01)00933-5

13. Agrawal V, Kucherov V, Bendana E, et al. Robot-assisted laparoscopic repair of vesicovaginal fistula: a single-center experience. Urology. 2015;86(2):276–281. doi:10.1016/j.urology.2015.02.074

14. Lecoanet P, Madanelo M, Tricard T, et al. Robot-assisted vesicovaginal fistula repair: comparison of the extravesical and transvesical techniques. Int Urogynecol J. 2023;34(10):2479–2485. doi:10.1007/s00192-023-05565-7

15. Tavares M, do Carmo Pinto M, Conde Carvalho G, Silva-Ramos M. Vesicovaginal fistula robotics-assisted repair: a systematic review and quantitative synthesis. Int Urogynecol J. 2026. doi:10.1007/s00192-026-06578-8

16. Panaiyadiyan S, Nayyar BU, Nayyar R, et al. Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up. Int Urogynecol J. 2021;32(9):2521–2528. doi:10.1007/s00192-020-04648-z

17. Lee D, Dillon BE, Lemack GE, Zimmern PE. Long-term functional outcomes following nonradiated vesicovaginal repair. J Urol. 2014;191(1):120–124. doi:10.1016/j.juro.2013.07.004

18. Shah SJ. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2009;23(7):1135–1137. doi:10.1089/end.2009.0080

19. European Association of Urology. Non-neurogenic Female LUTS guideline, section 4.8: urinary fistula. 2026 edition. Full guideline section.

20. O'Conor VJ, Sokol JK. Vesicovaginal fistula from the standpoint of the urologist. J Urol. 1951;66:579–585. PubMed record. doi:10.1016/s0022-5347(17)74381-9

21. Karram MM. Abdominal Repair of Vesicovaginal and Vesicouterine Fistula. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 5th ed. Elsevier; 2021:1079-1090.

22. Sotelo R, Moros V, Clavijo R, Poulakis V. Robotic repair of vesicovaginal fistula (VVF). BJU Int. 2012;109(9):1416-1434. doi:10.1111/j.1464-410X.2012.10148.x

23. Enemchukwu EA, Rosenblum N. Transvesical Repair of Vesicovaginal Fistula. In: Smith JA Jr, Dmochowski RR, Thomas JC, Preminger GM, eds. Hinman's Atlas of Urologic Surgery. 5th ed. Elsevier; 2025:444-449.

24. Zillioux J, Vasavada SP. Transperitoneal Vesicovaginal Fistula Repair. In: Smith JA Jr, Dmochowski RR, Thomas JC, Preminger GM, eds. Hinman's Atlas of Urologic Surgery. 5th ed. Elsevier; 2025:450-453.

25. Tenggardjaja CF, Goldman HB. Transabdominal Vesicovaginal and Vesicouterine Fistula Repair. In: Cardozo L, Staskin D, eds. Textbook of Female Urology and Urogynecology. Vol 2: Surgical Perspectives. 5th ed. CRC Press; 2023:1152-1159. doi:10.1201/9781003144243-117

26. Sayegh AS, Medina LG, Sotelo R. Vesicovaginal Fistula: Minimally Invasive Surgery (MIS) Approaches. In: Sotelo R, Polotti CF, Arriaga J, eds. Urinary Fistula. Springer; 2022:125-138. doi:10.1007/978-3-031-15317-4_11

27. Kata A, Michelson K, Wiegand LR. Preserve the tract and turn it inside out (PATIO) robotic vesicovaginal fistula repair: a novel approach. Urol Video J. 2026;31:100412. doi:10.1016/j.urolvj.2026.100412

28. Singh V, Mehrotra S, Bansal A, Akhtar A, Sinha RJ. "Prospective randomized comparison of repairing vesicovaginal fistula with or without the interposition flap: Result from a tertiary care Institute in Northern India." Turk J Urol. 2019;45(5):377–383. doi:10.5152/tud.2019.85233

29. Khorami MH, Zargham M, Taheri P, Gholipoor F, Safari M. "The Necessity of Incorporating an Interposition Flap During Vesicovaginal Fistula Repair: Can Modifying the Method of Vaginal Repair Serve as a Substitute? A Randomized Clinical Trial." Urol J. 2024;21(3):189–194. doi:10.22037/uj.v20i.7950

30. Sharma S, Rizvi SJ, Bethur SS, et al. Laparoscopic repair of urogenital fistulae: a single centre experience. J Minim Access Surg. 2014;10(4):180–184. doi:10.4103/0972-9941.141508

31. Tilala YM, Panda S, Paul AS, et al. Comparative analysis between laparoscopic extravesical repair and laparoscopic O’Connor repair for supratrigonal vesicovaginal fistula. Urol Res Pract. 2024;50(1):58–65. doi:10.5152/tud.2024.23147

32. Srivastava M, Mittal A, Panwar VK, Bahurupi Y, Mandal AK. "Transvaginal repair of supratrigonal, juxtacervical, vault, and apical vesicovaginal fistulae: a systematic review and meta-analysis." Urol Res Pract. 2025;51(3):117–130. doi:10.5152/tud.2025.24184