Video Section

International Braz J Urol
Official Journal of the Brazilian Society of Urology

Vol. 40 (3): 435-436, May - June, 2014
Laparoscopic Treatment of Vesicovaginal Fistula
Marcos Tobias-Machado 1, Pablo Aloisio Lima Mattos 1, Pedro Romanelli de Castro 2, Ricardo Hissashi Nishimoto 3, Antonio Carlos Lima Pompeo 1
1 Section of Minimally Invasive Surgery, Department of Urology, ABC Medical School, Santo André, São Paulo; 2 Section of Minimally Invasive Surgery, Mater Dei Hospital, Belo Horizonte, Minas Gerais and 3 Department of Urology, Minas Gerais Hospital Foundation, MG, Brazil
Introduction: Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported. Objectives: Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter. Results: Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months. Conclusions: Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.

Key Words:
Int Braz J Urol. 2014; 40 (Video #9): 435-6