Combined Laparoscopic, Vesicoscopic, and Vaginal Repair of a Vesicovaginal Fistula

Abstract

Study ObjectiveTo demonstrate a combined laparoscopic, vesicoscopic, and vaginal approach to repair of a complex vesicovaginal fistula. DesignTechnical video demonstrating a combined laparoscopic, vesicoscopic, and vaginal approach for repairing a vesicovaginal fistula (Canadian Task Force classification level III). SettingUrogynecology and Urology Departments of a tertiary referral center for urogynecology. InterventionsA 38-year-old woman presented with a vesicovaginal fistula secondary to a previous total abdominal hysterectomy. An initial attempt to repair the fistula vaginally was unsuccessful owing to infection and comorbidities. After counseling, the patient agreed to a combined laparoscopic, vesicoscopic, and vaginal repair of her vesicovaginal fistula. ConclusionThe incidence of vesicovaginal fistula following a total abdominal hysterectomy for benign causes is 1 in 540 [1]. Management of this complication can be challenging, and success rates vary. Initially, laparoscopy was performed, which allowed mobilization of the omentum to provide an interposition patch between the bladder and vagina after repair of the fistula. The fistula tract was then identified vesicoscopically and excised. Once the tract was closed and the patch secured, a vaginal approach was adopted to excise the remaining fistula tract as well as scar tissue. Interrupted closure of the vagina was performed in multiple layers to reduce the risk of recurrence. We have used vesicoscopy since 2007 for a variety of female urogynecologic problems, including bladder diverticula, ureteric stenosis, vesicoureteric reflux, foreign body removal, and vesicovaginal fistula repair [2]. This combined multidisciplinary approach offers a minimally invasive option for the repair of complex vesicovaginal fistulae, and should be considered in selected complex cases.