Transvesicoscopic repair of vesicovaginal fistula

Abstract

Introduction. Vesicovaginal fistula has been a social and surgical problem for centuries. Many surgical techniques have been developed to correct this abnormality, including transabdominal, transvaginal, and endoscopic approaches. The best approach is probably the one with which the surgeon feels most experienced and comfortable. Laparoscopy has become increasingly popular in urology, reducing the invasiveness of treatment and shortening the period of convalescence. We report our results of transvesicoscopic approach for VVF repair. Materials and Methods. Patients with VVF were offered repair using the transvesicoscopic route. With the patient under general anaesthesia and in modified lithotomy position cystoscopy was performed with gas insufflation. Under cystoscopic guidance the bladder was fixed to anterior abdominal wall and ports inserted into the bladder. The fistula was repaired under endoscopic vision. Results. Four women, who had VVF following abdominal hysterectomy, underwent this procedure. The operating time ranged from 175 to 235 minutes. There was minimal bleeding. Post operative complications included ileus in one and fever in another. No recurrence of VVF was noted in any patient. Conclusions. Transvesicoscopic repair of VVF is feasible, safe, and results in lower morbidity and quicker recovery time.

Figure 1

Transvesicoscpic vision of VVF.

Figure 2

Circumfistula dissection being made.

Figure 3

Closure of vagina vertically.

Figure 4

Bladder closure completed.