Robotic Repair of Vesicovaginal Fistula

Pham C1, Winter M2

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 422
Fistula, Diverticulum and Wild Card
Scientific Podium Video Session 26
Friday 9th September 2022
15:57 - 16:06
Hall G1
Female Fistulas Surgery
1. Department of Urology, Northern Beaches Hospital, Frenchs Forest, Australia, 2. Department of Urology, North Shore Private Hospital, St Leonards, Australia
Online
Presenter
Links

Abstract

Introduction
Vesicovaginal fistula (VVF) is a pathological communication between the posterior bladder wall and anterior vagina. A variety of techniques have been described in the literature but there has only recently been a consensus on best robotic surgical practice. [1] Robotic surgical technique has not been well described with visual demonstrations. We present an original video of a robotic-assisted repair of a VVF with trans-vesical approach and omental interposition.
Design
We outline the key steps in VVF repair, including a cystoscopy to establish the number, size and location of VVF. Bilateral double-J ureteric stents were inserted to protect the ureteric orifices. The VVF was marked by placing a guidewire through the defect via the vagina. A robotic-assisted VVF repair with trans-vesical approach was performed using the da Vinci Xi surgical system. The vesicovaginal space was dissected, the fistula track exposed and fistulectomy performed. Multi-layer, tension-free closure of the vagina and bladder with omental interposition was performed, followed by a leak test to ensure water tight closure. An indwelling catheter (IDC) was inserted at the conclusion of the case.
Results
There were no intra or post-operative complications. The patient was discharged on post-operative day 3 and the IDC was removed on post-operative day 10. At three month follow-up, she did not have ongoing incontinence or recurrence of the fistula.
Conclusion
Robotic repair of VVF is both safe and effective. Robotic surgery facilitates dissection of the vesicovaginal space, mobilization of an omental flap and multi-layer tension-free closure of the bladder and vagina.
References
  1. Randazzo, M., Lengauer, L., Rochat, C., Ploumidis et al. (2020). Best Practices in Robotic-assisted Repair of Vesicovaginal Fistula: A Consensus Report from the European Association of Urology Robotic Urology Section Scientific Working Group for Reconstructive Urology. European Urology, 78(3), 432-442
Disclosures
Funding None to declare Clinical Trial No Subjects Human Ethics Committee Northern Sydney Local Health District Human Research Ethics Committee Helsinki Yes Informed Consent Yes
Citation

Continence 2S2 (2022) 100396
DOI: 10.1016/j.cont.2022.100396

23/10/2024 07:42:46