Minimally invasive complete urinary tract drainage in the treatment of vesicovaginal fistula: A case report

Abstract

Vesicovaginal fistula is one of the most common types of female genitourinary fistulas encountered in clinical practice, and its treatment is determined by the disease characteristics and at the discretion of the attending physician. The present study describes a unique conservative approach to the management of vesicovaginal fistulas. A 56-year-old woman developed a vesicovaginal fistula after laparoscopic hysterectomy. A bilateral ureteral single-J tube drainage through suprapubic bladder puncture with indwelling catheterization was performed. Thus, urine diversion and bladder emptying were achieved. In addition, the healing of the vesicovaginal fistula was promoted and the trauma of open or laparoscopic surgery was avoided. This minimally invasive method is simple and convenient, has few complications, and may be used as an alternative method for treating vesicovaginal fistulas.

Keywords: case report; conservative treatment; laparoscopic hysterectomy; single J-tube; vesicovaginal fistula.

Figure 1

(A) Contrast-enhanced CT images of the urinary system on admission. (B) Cystoscopy indicated a vesicovaginal fistula. (C) Cystography indicated a vesicovaginal fistula. (D) CT images of the urinary system after cystography. (E) Contrast-enhanced CT images of the patient's urinary system at 3 months postoperatively. (F) A healed fistula was observed using cystoscopy at 3 months postoperatively. (G) A healed fistula was seen using cystography at 3 months postoperatively. (H) Colposcopy revealed a healed fistula with visible scarring at 3 months postoperatively. CT, computed tomography.

Figure 2

(A) Suprapubic bladder puncture performed under cystoscopy. (B) A single J-tube was placed using a guide wire under cystoscopy. (C) Successful placement of a single J-tube in one ureter, preparation for the placement of the other. (D) Bilateral single J-tubes successfully inserted under cystoscopy.