Laparoscopic transvesical vesicovaginal fistula repair with the least invasive way:Only three trocars and a limited posterior cystotomy

Objective:Two conventional approaches for vesicovaginal fistula(VVF)repair are transabdominal repair for supratrigonal VVF and transvaginal approach for low lying fistulae.Laparoscopic surgery was introduced to duplicate the surgical steps of the transabdominal approach with reduction in morbidity.We report a series of patients treated with a modified laparoscopic technique which includes the use of only three trocars and a limited posterior cystotomy.Methods:We retrospectively reviewed the data of eight patients who underwent laparoscopic VVF repair with our standardized technique from January 2015 to April 2018.Only cases with a supratrigonal fistula were included.We constantly used only three trocars.A limited 2 cm midline posterior cystotomy was performed using ultrasonic energy.A stay suture on a straight needle was passed percutaneously in the abdomen,then on either side of the cystotomy and finally was exteriorized to maintain countertraction.The cystotomy was extended downwards to include the fistula site.The fistula was dissected circumferentially to raise the bladder and vaginal flaps.The vaginal defect was closed in a transverse fashion and the cystotomy was closed vertically.Results:Mean operative time was 17831.6 min and estimated blood loss was 6018.7 mL.Flap interposition was performed in six cases.No intraoperative complications were recorded.Mean hospital stay was 2.250.89 days.During hospitalization two patients experienced postoperative complications(Clavien grade I).Mean follow-up was 20.911.1 months(6.0e39.0 months).All patients remained continent during the follow-up period.Conclusions:This minimally invasive laparoscopic approach with only three trocars and limited posterior cystotomy provides excellent results with minimum morbidity.

Complete Cervico-Uretral Transections: A Vesicovaginal Fistula Not Like the Other

Introduction: Complete cervico-urethral transection is a vesicovaginal fistula characterized by total disinsertion of the urethra from the bladder. It is a fistula of the cervico-urethral intersection threatening the mechanism of continence. The aim of this study was to describe the epidemiological and therapeutic aspects of this type of fistula. Patients and Methods: This was a descriptive retrospective study on patients who have had surgery for cervico-urethral transection from June 01, 2012 to June 01, 2015. Results: Cervico-urethral transections (n = 76) accounted for 33.77% of all urogenital fistulas admitted to our department of surgery during the study period. The average age was 25.02 ± 8, 6 years. Married patients accounted for 85.58%, 72.36% had not received any classical education. Fistulas less than one year old made up 56.58% of cases, associated lesions were perineal tears 25.0%, vaginal sclerosis, 21.05%, vaginal straps, 13.15%, rectovaginal fistula, 2.63% and the shortness of the urethra less than 2.5 cm in 42.10% of cases. All surgeries were performed vaginally with a 98.68% fistula closure rate and an average of 1.68 surgeries per patient. After closure of the fistula, 10.67% of patients presented a residual urinary incontinence. Conclusion: Complete cervico-urethral transection is a frequent vesicovaginal fistula. She sometimes exposes to urinary incontinence after closing the fistula. The results of his surgery are often good at the cost of multiple intervention.

Risk Factors for Urinary Incontinence after Obstetric Vesicovaginal Fistula Closure in Guinea

Introduction: Urinary incontinence after closure of vesicovaginal fistula is any involuntary loss of urine that a patient complains of. We aim to study the risk factors for urinary incontinence after closure of obstetric vesicovaginal fistula in Guinea in order to develop preventive measures to reduce its incidence. Materials and Methods: This was a retrospective, multiple center cohort of women operated on for obstetric vesicovaginal fistula during a 10-year period. Results: In 1770 vesicovaginal fistulas operated, 1347 were closed. 180 women (13.36%) developed urinary incontinence. After multivariate analysis, the risk factors of urinary incontinence after closure of vesicovaginal fistula were: the patient’s age, the anatomical type III, iterative surgical intervention, the brevity of the urethra and decrease in bladder capacity. Conclusion: Urinary incontinence after closure of vesicovaginal fistula is a frequent problem in Guinea, the prevention of which should be integrated into the management of fistulas.

Vesico-Vaginal and Recto-Vaginal Fistula and Death Caused by a Vaginal Foreign Body in a Body-Packer

Foreign body retained for long duration sometimes causes vesico-vaginal and recto-vaginal fistula. We report a 60-year-old woman with vaginal foreign body causing vesico-vaginal and recto-vaginal fistula;she died after foreign body removal due to septic shock. The patient had vaginal purulent discharge, abdominal pain, and a septic shock. A fragment of stone (limestone) was present in the vagina, which was removed. The patient developed urinary incontinence and fecal incontinence after removal of the foreign body. The examination demonstrated the presence of vesico-vaginal and recto-vaginal fistula. The patient died four days after removal of the foreign body due to septic shock and multi-visceral failure. During the extraction foreign body, bacteria could be disseminated into the systemic circulation and might cause septic shock. Thus, wide-spectrum antibiotic therapy must be used before the procedure, which may decrease the chance of septic shock.