Repair Of Complex Vesicovaginal Fistula Research Articles

Robot-assisted Repair of Complex Vesicovaginal Fistulae: Feasibility and Outcomes

OBJECTIVETo share our experience and techniques of robot-assisted repair of complex vesicovaginal fistulae. METHODSProspectively maintained data of patients undergoing robot-assisted repair of complex vesicovaginal fistula (VVF) from December 2014 to October 2019 were analyzed. Patient characteristics, operative data, postoperative events, and follow-up outcomes were noted. All cases underwent preoperative cysto-vaginoscopy and upper tract imaging. The procedure was completed in a standard fashion. Additional procedures included Boari flap reimplantation, Burch-colposuspension, ureteric reimplantation and Vaginal flap incorporation. On follow-up, successful repair was defined as no urine leak after removal of catheter. RESULTSOut of 73 patients undergoing robot-assisted VVF repair at our institute, 33 were classified as complex VVF. Mean age was 42.7 ± 7.2 years. The most common cause of VVF was posthysterectomy (81.8%) with 21 (63.1%) recurrent VVFs. Thirty patients (90.0%) had supratrigonal fistulae; multiple fistulae were present in 3 cases. Two patients underwent Boari flap ureteric reimplantation for concomitant ureteric stricture and ureteric neocystostomy was required in another patient. One patient underwent our novel technique of vaginal flap incorporation and a Burch colposuspension was performed simultaneously in one patient with stress incontinence. The median follow-up was 35 months (interquartile range 8.5months). Successful outcome was noted in 31 (93.9%) patients; recurrence requiring further repair in 2 patients. CONCLUSIONThe current series presents the largest number of complex VVFs repaired by robotic assistance. Robot-assisted repair can be considered as one stop procedure for such complex and vexing problems.

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

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.

Combined Vaginal and Vesicoscopic Collaborative Repair of Complex Vesicovaginal Fistulae

This study aimed to describe and demonstrate the feasibility of a minimally invasive surgical technique for the repair of complex vesicovaginal fistulae that may not be amenable to vaginal repair. Nine cases of vesicovaginal fistulae, which were repaired laparoscopically at King's College Hospital, London and Ygia Polyclinic Private Hospital, Limassol between 2011 and 2013, were identified. The repair was carried out by direct placement of the ports into the urinary bladder (vesicoscopy). Preoperative, intraoperative, and postoperative data were collected from a prospective database. All 9 operations were completed without any conversion to open surgery. Four ureteric reimplantations were necessary for ureteric involvement. There were no intraoperative complications but some intraoperative technical difficulties. No early postoperative complications were documented, and the hospital stay varied from 2 to 8 days. The fistula repair success rate was 89% at a median follow-up of 30 months. This surgical technique is feasible and offers an alternative approach to the classical open or laparoscopic transperitoneal approach. It supplements the vaginal approach for fistulae that are not suitable for pure vaginal approach, allowing close collaboration between the laparoscopic urologist and the vaginal surgeon.

Experience with the immediate treatment of iatrogenic bladder injuries and the repair of complex vesico-vaginal fistulae by the transvesical approach.

We describe our experience in treating 16 established cases of vesicovaginal fistulae in non-irradiated bladders which followed obstetric and gynecological procedures. The fistulae, most of which were large and complex, were successfully repaired surgically after two to three months intervals, using the O'Connor transvesical technique. The advantages of late correction using the transvesical approach in such cases are discussed. Thirteen additional cases of accidental bladder injuries during obstetric and gynecological procedures are presented. These injuries were successfully treated by immediate primary sutures. Our experience shows that bladder injuries mainly occur in women who had previously had a Cesarean section.