Laparoscopic Transureteroureterostomy with Ileal Conduit in Postradiation Vesicovaginal Fistula

Abstract

Abstract Background: This article describes a technique of a minimally invasive, palliative approach for postradiation vesicovaginal fistula (VVF). Case: A 55-year-old female presented with locally advanced carcinoma of the cervix for which she underwent radiotherapy in 2006. She developed a rectovaginal fistula in September 2007 and had a sigmoid loop colostomy. She then developed a large VVF in March 2008. She also had bilateral hydroureteronephrosis with a raised creatinine level. Repair of the VVF was not technically feasible and the option of diversion by an ileal conduit was discussed. As it was not advisable to take a long loop of ileum to reach the left ureter in a patient with renal impairment and it was necessary to avoid devascularisation of the left ureter (because of the patient's irradiated pelvis); a left-to-right transureteroureterostomy was done (laparoscopically). A uretero-ileal anastomosis and an ileal conduit were fashioned transportally (in laparoscopic-assisted procedure). Results: ...