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. 2014 Oct;10(4):180-4.
doi: 10.4103/0972-9941.141508.

Laparoscopic repair of urogenital fistulae: A single centre experience

Sumit Sharma  1 , Syed Jamal Rizvi  1 , Santhosh Shivanandaiah Bethur  1 , Jyoti Bansal  1 , Syed Javid Farooq Qadri  1 , Pranjal Modi  1
Affiliations

Laparoscopic repair of urogenital fistulae: A single centre experience

Sumit Sharma et al. J Minim Access Surg. 2014 Oct.

Abstract

Context: Sparse literature exists on laparoscopic repair of urogenital fistulae (UGF).

Aims: The purpose of the following study is to report our experience of laparoscopic UGF repair with emphasis on important steps for a successful laparoscopic repair.

Settings and design: Data of patients who underwent laparoscopic repair of UGF from 2003 to 2012 was retrospectively reviewed.

Materials and methods: Data was reviewed as to the aetiology, prior failed attempts, size, number and location of fistula, mean operative time, blood loss, post-operative storage/voiding symptoms and episodes of urinary tract infections (UTI).

Results: Laparoscopic repair of 22 supratrigonal vesicovaginal fistulae (VVF) (five recurrent) and 31 ureterovaginal fistulae (UVF) was performed. VVF followed transabdominal hysterectomy (14), lower segment caesarean section (LSCS) (7) and oophrectomy (1). UVF followed laparoscopy assisted vaginal hysterectomy (18), transvaginal hysterectomy (2) and transabdominal hysterectomy (10) and LSCS (1). Mean VVF size was 14 mm. Mean operative time and blood loss for VVF and UVF were 140 min, 75 ml and 130 min, 60 ml respectively. In 20 VVF repairs tissue was interposed between non-overlapping suture lines. Vesico-psoas hitch was done in 29 patients of urterovaginal fistulae. All patients were continent following surgery. There were no urinary complaints in VVF patients and no UTI in UVF patients over a median follow-up of 3.2 years and 2.8 years respectively.

Conclusion: Laparoscopic repair of UGF gives easy, quick access to the pelvic cavity. Interposition of tissue during VVF repair and vesico-psoas hitch during UVF repair form important steps to ensure successful repair.

Keywords: Laparoscopy; O'Connor; ureteroneocystotomy; ureterovaginal fistula; urogenital fistula; vesico-psoas hitch; vesicovaginal fistula.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Bladder flaps have been dissected off the fistula. (b) Horizontal closure of fistula. (c) Interposing the omentum between suture lines. (d) Vertical closure of cystotomy
Figure 2
Figure 2
(a) Left vesico-psoas hitch with detrussorotomy. (b) Cystotomy with jet of urine seen. (c and d) Apical stitch of ureteroneocystotomy and subsequent suturing
Figure 3
Figure 3
(a) Intravenous urography (IVU) showing bilateral ureteral injury with extravasation of contrast from lower third of ureter. (b) Retrograde ureteropyelogram showing right lower ureteral narrowing and complete cut off in lower third of left ureter. (c) Completed repair showing bilateral ureteroneocystotomy with right side vesico-psoas hitch. (d) Post-operative IVU showing prompt drainage of contrast into urinary bladder without any extravasation
See this image and copyright information in PMC

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