INTRODUCTION:
Genitourinary fistulae (GUF), one of the most devastating complications in the urogynaecology settings, includes vesicovaginal fistulae (VVF), vesicouterine fistulae (VUF), ureterovaginal fistulae (UVF) and Urethrovaginal fistulae; VVF being the most common type. GUF continue to pose significant surgical and psychosocial challenges for affected women, especially in developing countries. Historically, Transabdominal and Transvaginal repairs were the mainstay of treatment, often delivering satisfactory results in experienced hands. However, with the advancement in minimally invasive technologies, the role of robot-assisted laparoscopic repair has emerged a powerful alternative, offering precision, reduced morbidity and better patient reported outcomes. Here we share our 5-year-experience in the management of genitourinary fistulae with changes in the emerging technologies.


AIM OF STUDY:
In this study we discuss the changing trends in the surgical management of Genitoruinary fistulae repair from conventional to robot assisted laparoscopic repair, comparing their outcomes and further need in the improvement in surgical techniques.

STUDY DESIGN AND METHOD:
We retrospectively reviewed 30 cases of genitourinary fistulae managed at our Urology ward in Jinnah Post Graduate Medical Centre between the years 2020-2025. The distribution of surgical approaches is as follows.
-	Transabdominal repair – 15 cases
-	Transvaginal repair – 10 cases
-	Robot assisted laparoscopic repair – 5 cases

RESULTS:
In our study, we observed that Transbdominal repair, although effective, was associated with higher morbidity, longer hospital stay, increase chances of wound infection and delayed return to normal life. While Transvaginal and Robot assisted repair had fewer complications, with quick recovery time. Robot assisted laparoscopic repair, being the minimal invasive technology had decrease hospital stay and minimal morbidity.

Results were interpreted by reviewing the patients records and data was analyzed using SPSS software.

CONCLUSION:
Our 5-year-experience reflects a paradigm shift in the management of genitourinary fistulae. While all the three approaches – Transabdominal, Transvaginal and Robot-assisted – remain valid, robot assisted repair offers the most favorable outcome in terms of minimal morbidity, decrease hospital stay, wound complications and quality of life. It also offered superior magnified 3D visualization and improved dexterity, leading to enhanced dissection and suturing, particularly beneficial in complex and recurrent fistulae. While Transvaginal repair also offers decrease morbidity, decrease chances of wound infection and early return to normal life as compared to Transabdominal repair.

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