Laparoscopic Repair of Vesicovaginal Fistula: our experience
Abstract
Abstract
Study Objective
Technical video demonstrating a combined cystoscopic, laparoscopic, and vaginal approach to repair of a vesicovaginal fistula (VVF).
Case presentation
We present the case of a 72-year-old woman affected by urinary incontinence (UI) and pelvic prolapse organ prolapse (POP) for about 2 years. Therefore, she underwent a colpohysterectomy surgery and cistopexy and colpoperineoplasty.
After 10 days, the patient returned our attention for recurrent episodes of UI (4-5 pad/die).
A hysterography revealed a fistula of 8 mm diameter at the posterior wall of the bladder, supratrigonal in position. We chose the laparoscopic approach to treat the VVF.
During cystoscopy, ureters and the fistula tract were catheterized previously.
In this way, the time of laparoscopy was beneficial to localize the fistula tract and allowed meticulous dissection in the retrovesical space between the bladder and the vagina.
The sutures of the bladder and vagina were performed in a perpendicular direction, without overlap and tension of the vaginal mucosa. [1]
Bladder closure was confirmed by the hydrostatic leak test at 250 cc.
The attempt to place the epiploic appendagitis was unsuccessful, it caused tension and angle of the rectum. Alternatively, we used an omental flap to repair the VVF. [2]
Results
Operating time was approximately 150 min. Estimated blood loss was 50 mL. No intraoperative or postoperative complications occurred. The bladder catheter was removed after 15 days, after which the control cystography showed no leakage. The woman had no signs of recurrence after 12 months of follow-up.
Conclusion
Laparoscopic repair of VVF is a feasible, effective, and mini-invasive management option of treatment with successful outcome. [3]
1. Prognostic factors of recurrence after vesicovaginal fistula repair. Mohsen Ayed, Rabii El Atat, Lotfi Ben Hassine, Mohamed Sfaxi, Mohamed Chebil, Saadoun Zmerli. Comparative Study Int J Urol 2006 Apr;13(4):345-9. doi: 10.1111/j.1442-2042.2006.01308.x.
2. Kiricuta I, Goldstein AMB. The repair of extensive vesicovaginal with pedicled omentum: a review of 27 cases. J Urol. 1972;108:724–7
3. Miklos JR. Laparoscopic treatment of vesicouterine fistula. J Am Assoc Gynecol Laparosc. 1999;6(3):339-341.