Consensus statements on the definition of surgical success following obstetric urinary pelvic floor fistula repair: An IUGA-ICS proposal

Standardized definitions for surgical success after obstetric urinary pelvic floor fistula (UPF) repair are lacking. This study aimed to establish a consensus among fistula surgeons on defining surgical success for UPF repair caused by obstetric (childbirth-related) injuries. A working group was initiated by the International Urogynecology Association (IUGA) in collaboration with the International Continence Society (ICS). Following a systematic literature review, statements were developed, and a Delphi method was applied to reach a consensus on each statement. Consensus was reached on 34/44 statements (77.3%). These were grouped into five categories: (1) definition of outcome, (2) treatment and outcome assessment, (3) post-fistula repair urinary incontinence, (4) incurable fistula, and (5) quality of life. The consensus group recommends defining surgical success as anatomical closure of the fistula without residual urinary incontinence, as closure alone is insufficient. Women with residual urinary incontinence should not be classified as cured and require further diagnostic and therapeutic intervention. A postoperative dye test at catheter removal is advised as an objective measure of surgical success. The group also underscores the importance of basic urodynamic evaluation to assess residual incontinence following fistula closure. A diagnosis of “incurable” fistula should only be considered after three failed repairs and requires independent assessments by two expert surgeons. Finally, clinical success should include improvements in patient quality of life, and a specialized, validated quality-of-life questionnaire is essential to evaluate the physical, social, and emotional impact of UPF on patients and to assess treatment effectiveness from the patient's perspective. The consensus statements aim to standardize the definition of successful outcomes in obstetric UPF repair, guiding future research and patient counseling. The group encourages further investigation into existing knowledge gaps in obstetric urinary pelvic floor fistula.