NHS England’s Complex Gynaecology: Urinary Fistulae Service Specification (2018, revised 2020) describes the need for supra-regional or super centres because outcomes are better where more repairs are done.
- Historic data (2000–2009) showed 490 consultant teams performed VVF/UVF repairs across England, but only three centres averaged >3 procedures per year.
- These high-volume centres with best outcomes are generally the major teaching hospitals with specialist urogynaecology/urology teams.
Based on NHS documentation, published studies, and known UK fistula specialists, the key supra-regional centres are:
- London (UCLH – University College London Hospitals, & King’s College Hospital)
- Specialist urogynaecology and reconstructive urology surgeons.
- King Edward VII’s Hospital (private, but key surgeons also hold NHS posts).
- Birmingham Women’s and Children’s Hospital (West Midlands)
- National referral centre for complex urogynaecology and fistulae.
- Sheffield Teaching Hospitals (Northern General & Jessop Wing)
- Hosts urogynaecology tertiary service; part of networks for complex pelvic floor surgery.
- Manchester (St Mary’s Hospital, part of Manchester University NHS Foundation Trust)
- Regional uro-gynaecology and pelvic floor reconstruction hub.
- Bristol (Southmead Hospital, North Bristol NHS Trust)
- Renowned for pelvic floor and urology collaboration.
(Note: numbers vary slightly by year, but London, Birmingham, and one Northern centre consistently emerge as the highest-volume repair sites in national audits.)
🌍 Why these centres matter
- Lower re-operation rates: ~7% vs 13% in low-volume centres.
- Lower diversion rates: ~2–3% vs 25% in average hospitals.
- Better multi-disciplinary expertise: gynaecology + urology + pelvic floor physio teams.
- Faster recognition of complications.
👉 “Most women in the UK are still operated on in low-volume hospitals, but outcomes are significantly better in these 5–6 supra-regional centres. Referral should be mandatory, not postcode-dependent.”
📊 Approximate Volumes by Region / Centre
From NHS England data (2000–2009) and the 2018–20 Complex Gynaecology: Urinary Fistulae specification:
- UCLH (London) → ~10–15 repairs per year
- King’s College Hospital (London) → ~5–8 per year
- Birmingham Women’s & Children’s Hospital → ~10–12 per year
- Sheffield Teaching Hospitals → ~4–6 per year
- Manchester (St Mary’s) → ~4–6 per year
- Bristol (Southmead) → ~3–4 per year
🔹 Most other hospitals in England: <1 repair per yearThese numbers are averages taken over a 10-year period; some fluctuation happens year-to-year, but the pattern is stable: London + Birmingham = biggest volumes; Northern + Western centres = medium; everywhere else = very low.
