- According to NHS England data, there are up to 100 centres coding activity for urinary or vesicovaginal fistula repairs. However, most units perform fewer than one procedure per year. Only a few specialist or supra-regional centres manage a higher volume of cases .
- Geographically, services are unevenly distributed:
- North: 6 specialised providers
- Midlands & East: 19 providers
- London: 4 providers
- South: 4 providers
This highlights more comprehensive coverage in the Midlands & East, with sparser provision in London and the South .
Volume, Outcomes & Specialist Centralisation
- A retrospective study of English NHS hospitals over 2000–2009 found that:
- 905 VVF/UVF repairs and 289 urinary diversion procedures were performed across 490 consultant teams .
- 281 of these teams performed just one repair over ten years—indicating extremely low volume per unit .
- Only three centres averaged more than three procedures per year .
- Outcome data showed:
- Hospitals performing >30 procedures over 10 years had significantly lower re-operation rates (7.4%), compared with those doing fewer procedures (13.2%) .
- The overall urinary diversion rate was ~25.5%, but in the highest-volume centre, it was only 2.7%, suggesting higher expertise leads to more conservative and successful repair approaches .
Summary Table: Regional Variation Snapshot
| Region / Metric | Data Summary |
| Number of providers by region | North: 6 Midlands & East: 19 London: 4 South: 4 |
| Total care centres across England | Up to 100 units coding VVF repair, most very low volume |
| Centres with 3+ repairs/year | Only 3 supra-regional/specialist centres |
| Re-operation rate (high-volume centres) | 7.4% (vs 13.2% in low-volume centres) |
| Urinary diversion use (high-volume vs average) | 2.7% (specialist centre) vs 25.5% (national average) |
- Significant regional disparity exists in access to specialist VVF surgical care.
- Most units see these cases very infrequently, which may impact surgical proficiency and patient outcomes.
- Centralizing care to specialist high-volume centres appears to improve outcomes:
- Lower re-operation rates
- Reduced likelihood of being subjected to diversion rather than repair
- As an organisation focused on VVF, we intend to play a crucial role in:
- Advocating for centralised referral pathways,
- Supporting patient navigation to high-quality centres,
- Raising awareness with ICBs, NHS trusts, and policymakers about the benefits of centralisation,
- Ensuring equitable access across regions.
- Each year, 100–150 women in the UK are diagnosed with vesicovaginal fistula (VVF).
- Treatment is surgical, but access to specialist, high-quality repair is highly uneven across the country.
- Current provision is fragmented, with up to 100 centres coding for urinary fistula repair — but the vast majority perform fewer than one case per year.
| Region | Providers | Notes |
| North | 6 | Patchy coverage; few high-volume units |
| Midlands & East | 19 | Most centres nationally, but still mostly low-volume |
| London | 4 | Major teaching hospitals, but numbers low |
| South | 4 | Very limited provision |
- Outcomes vary by centre volume:
- Hospitals doing >30 repairs over 10 years had a 7.4% re-operation rate.
- Hospitals with low volume had 13.2% re-operation rate.
- Urinary diversion rates (more invasive than repair):
- 25.5% nationally.
- Just 2.7% in the highest-volume centre.
- Patients in low-volume regions risk unnecessary re-operations or being diverted to permanent solutions instead of optimal repair.
- Centralise VVF care to a smaller number of supra-regional centres of excellence.
- Establish clear referral pathways so women are directed to expert surgeons quickly.
- Improve national reporting and data collection to track outcomes and ensure equity.
- Fund specialist patient navigation and support services (helplines, peer groups, advocacy).