Same problem, different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair—case report

• Published in: Translational andrology and urology Vol. 10; no. 10; pp. 3885 - 3890
• Main Authors: Hernández-Hernández, David, Navarro-Galmés, Miguel Ángel, Padilla-Fernández, Bárbara, Ramos-Gutiérrez, Víctor Javier, Castro-Díaz, David Manuel
• Format: Journal Article
• Language: English
• Published: AME Publishing Company 01.10.2021
• Subjects: Case Report
• ISSN: 2223-4683; 2223-4691
• DOI: 10.21037/tau-21-373

Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O’Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.