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Single-Port Transvesical Vesico-Vaginal Fistula Repair: An Initial Experience

ABSTRACT

Introduction

Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (11. Hillary CJ, Osman NI, Hilton P, Chapple CR. The Aetiology, Treatment, and Outcome of Urogenital Fistulae Managed in Well- and Low-resourced Countries: A Systematic Review. Eur Urol. 2016;70:478-92. doi: 10.1016/j.eururo.2016.02.015.
https://doi.org/10.1016/j.eururo.2016.02...
). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (22. Meneses AD, Oliveira AQ, de Araujo DA, Santos DT, de Carvalho LY, Eulalio WMN Filho, et al. Transabdominal and transvesical laparoscopic correction of vesico-vaginal fistula: 42 cases experience. Int Braz J Urol. 2020;46:296-7. doi: 10.1590/S1677-5538.IBJU.2018.0743.
https://doi.org/10.1590/S1677-5538.IBJU....
55. Gupta NP, Mishra S, Hemal AK, Mishra A, Seth A, Dogra PN. Comparative analysis of outcome between open and robotic surgical repair of recurrent supra-trigonal vesico-vaginal fistula. J Endourol. 2010;24:1779-82. doi: 10.1089/end.2010.0049.
https://doi.org/10.1089/end.2010.0049...
). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access.

Materials and Methods

Four patients with a diagnosis of VVF underwent SP-TV VVF repair between May 2022 and December 2023. Diagnosis was confirmed by cystoscopy, cystogram and in two cases by CT Urogram. Under general anesthesia, before robotic time, patients were placed in lithotomy position and a preliminary cystoscopy was performed. Fistula was noted and a 5fr stent was placed through the fistulous tract. Two ureteral stents were placed. Then, with patient supine, a transverse suprapubic 3cm incision and 2cm cystotomy were made for SP access. First step was to mark and remove fistula tract to the vagina. The edges of the vagina and bladder were dissected in order to have a closure free of tension and to create three different layers to close: vagina, muscularis layer of the bladder and mucosal layer of the bladder. A bladder catheter was placed, and the two ureteral stents were removed at the end of procedure.

Results

Mean age was 53 years old and three out of 4 patients developed VVF after gynecologic surgery. Two patients underwent VVF repair 6 and 8 months after total hysterectomy. One patient developed VVF after total hysterectomy and oophorectomy followed by radiation therapy. Last patient developed VVF after previous urological procedure. Fistula diameter was between 11 and 15mm. Operative time was 211 min, including preliminary cystoscopy, stents placement and SP-access. All patients were discharged on the same day with a bladder catheter, successfully removed between post-operative day 14-18 after negative cystogram. Only in one case a ureteral stent was left because the fistula was closed to the ureteral orifice and we reported one case of UTI twelve days after surgery, treated with outpatient antibiotics. Mean follow-up was 8 months, patients were scheduled for regular follow-up visits and no recurrence was reported. All patients have at least 3 months of post-operative follow-up.

Conclusions

Our experience suggests that SP Transvesical VVF repair may be considered as a safe and feasible minimally invasive treatment for small/medium fistulae (10-15mm).

REFERENCES

  • 1
    Hillary CJ, Osman NI, Hilton P, Chapple CR. The Aetiology, Treatment, and Outcome of Urogenital Fistulae Managed in Well- and Low-resourced Countries: A Systematic Review. Eur Urol. 2016;70:478-92. doi: 10.1016/j.eururo.2016.02.015.
    » https://doi.org/10.1016/j.eururo.2016.02.015
  • 2
    Meneses AD, Oliveira AQ, de Araujo DA, Santos DT, de Carvalho LY, Eulalio WMN Filho, et al. Transabdominal and transvesical laparoscopic correction of vesico-vaginal fistula: 42 cases experience. Int Braz J Urol. 2020;46:296-7. doi: 10.1590/S1677-5538.IBJU.2018.0743.
    » https://doi.org/10.1590/S1677-5538.IBJU.2018.0743
  • 3
    Colenbrander J, Heesakkers J, Martens F. Vesico-Vaginal Fistula Repair by a Vaginal Approach. Urol Int. 2021;105:1113-8. doi: 10.1159/000519369.
    » https://doi.org/10.1159/000519369
  • 4
    Antonelli A, Veccia A, Morena T, Furlan M, Peroni A, Simeone C. Robot-assisted vesico-vaginal fistula repair: technical nuances. Int Braz J Urol. 2021;47:684-5. doi: 10.1590/S1677-5538.IBJU.2020.0749.
    » https://doi.org/10.1590/S1677-5538.IBJU.2020.0749
  • 5
    Gupta NP, Mishra S, Hemal AK, Mishra A, Seth A, Dogra PN. Comparative analysis of outcome between open and robotic surgical repair of recurrent supra-trigonal vesico-vaginal fistula. J Endourol. 2010;24:1779-82. doi: 10.1089/end.2010.0049.
    » https://doi.org/10.1089/end.2010.0049

Publication Dates

  • Publication in this collection
    02 Aug 2024
  • Date of issue
    Jul-Aug 2024

History

  • Received
    11 Mar 2024
  • Accepted
    20 Mar 2024
  • Published
    07 May 2024
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