Laparoscopic extirpation of vesicovaginal fistula
Ruml Dóra Adrienn dr., Pusztai Csaba dr.
Somogy Megyei Kaposi Mór Oktató Kórház,
Urológiai Osztály, Kaposvár
(osztályvezető: Pusztai Csaba dr.)
Objective: Vesicovaginal fistula is the most common form of urinary fistula, which evolves in developed countries as a result of iatrogenicity, during gynaecological surgeries. The location of the fistula determines whether the surgical solution is transvaginal or transabdominal. In recent years, laparoscopic and robot assisted reconstruction has been gaining ground in addition to open surgery.
Patient/material and methods: In the past years, laparoscopic vesicovaginal fistula extirpation was performed on four patients. All of them underwent abdominal hysterectomy and the fistula was supratrigonal. To identify the fistula opening, at the beginning of the operation, a ureteral catheter was led from the bladder through the fistula into the vagina using a cystoscopy. Four laparoscopic ports were used during operation. After preparation, the fistula opening was circularly released, and then the ureteral catheter was cut and removed. The openings of the bladder and vaginal walls with refreshed edges were closed separately with mutually perpendicular stitches. After making sure that there was no leakage, we fixed a catheter in the bladder, which was removed in the 2nd postoperative week.
Results: The eradication of the vesicovaginal fistula proved to be successful in all cases, and the postoperative period was uncomplicated. The average length of the operations was 135 minutes, while the subsequent hospitalization was 4-7 days. The median age of the patients was 46 years. An average of 6.5 months passed between the gynaecological surgery and the laparoscopic reconstruction.
Discussion: Our experience confirms that laparoscopic vesicovaginal fistula closure can be used effectively if the preoperative diagnosis is adequate and the conditions are provided. As a result of the smaller surgical load the postoperative hospitalization period is also shortened. Monitoring the recovery period is important to prevent possible recurrence. In the early postoperative period, the wear of a permanent catheter is required, as well as physical restraint and total coitus prohibition.