Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience

Abstract

Introduction and hypothesis

Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae.

Methods

A retrospective analysis of our records over the last 10 years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded.

Results

Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25 min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2 days. After a mean follow-up of 6.3 ± 3.1 years, all patients had undergone successful repair, except for one patient with complex VVF.

Conclusions

Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. 2001;11:417–21.

    CAS  Article  Google Scholar 

  2. 2.

    Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;9:215–20.

    Google Scholar 

  3. 3.

    Knipe W. Vesico-uterine fistula. Am J Obstet Gynecol. 1908;57:211–7.

    Google Scholar 

  4. 4.

    Youssef AF. “Menouria” following lower segment cesarean section. A syndrome. Am J Obstet Gynecol. 1957;73:759–67.

    CAS  Article  Google Scholar 

  5. 5.

    Miklos JR. Laparoscopic treatment of vesicouterine fistula. J Am Assoc Gynecol Laparosc. 1999;7:211–7.

    Google Scholar 

  6. 6.

    Ibachie G, Njoku O. Vesico-uterine fistula. Br J Urol. 1985;57:438–9.

    Article  Google Scholar 

  7. 7.

    Smith RE. Ureteral injuries associated with gynecologic surgery. Prevention and management. Clin Obstet Gynecol. 1976;19:623–44.

    Article  Google Scholar 

  8. 8.

    Payne C. Ureteral injuries in the female. Fistulas and obstruction. In: Raz S, editor. Female urology. 2nd ed. Philadelphia: Saunders; 1996. p. 507–20.

    Google Scholar 

  9. 9.

    Stothers L, Chopra A, Raz S. Vesicovaginal fistula. In: Raz S, editor. Female urology. Philadelphia: Saunders; 1996. p. 490–506.

    Google Scholar 

  10. 10.

    Oakley S, Brown H, Greer J, Richardson M, Adelowo A, Yurteri-Kaplan L, et al. Management of vesicovaginal fistulae: a multicentre analysis from the fellows pelvic research network. Female Pelvic Med Reconstr Surg. 2014;20(1):7–139.

    Article  Google Scholar 

  11. 11.

    Ghoniem GM, Warda HA. The management of genitourinary fistula in the third millennium. Arab J Urol. 2014;12:97–105.

    Article  Google Scholar 

  12. 12.

    Abdel-Karim AM, Moussa A, Elsalmy S. Laparoendoscopic single-site surgery extravesical repair of vesicovaginal fistula: early experience. Urology. 2011;78(3):567–71.

    Article  Google Scholar 

  13. 13.

    Abdel-Karim AM, Elmissiry M, Aboulfotoh A, Moussa A, Elsalmy S. Laparoendoscopic single-site surgery (LESS) and conventional laparoscopic extravesical repair of vesicouterine fistula: single-center experience. Int Urol Nephrol. 2013;45:995–1000.

    Article  Google Scholar 

  14. 14.

    Chibber PJ, Shah HN, Jain P. Laparoscopic O’Conor’s repair for vesico-vaginal and vesico-uterine fistulae. BJU Int. 2005;96(1):183–6.

    Article  Google Scholar 

  15. 15.

    Porpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A, et al. Contemporary urologic minilaparoscopy: indications, technique and surgical outcomes in multiinstitutional European cohort. J Endourol. 2014;28(8):951–7.

    Article  Google Scholar 

  16. 16.

    Kaouk J, Gill I. Laparoscopic reconstructive urology. J Urol. 2003;170(4):1070–8.

    Article  Google Scholar 

  17. 17.

    Nezhat CH, Nezhat F, Nezhat C, Rottenberg H. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. 1994;83:899–901.

    CAS  PubMed  Google Scholar 

  18. 18.

    Tiong HY, Shim T, Lee YM, Tan JK. Laparoscopic repair of vesicovaginal fistula. Int Urol Nephrol. 2007;39:1085–90.

    Article  Google Scholar 

  19. 19.

    Puntambekar SP, Desai R, Galagali A, et al. Laparoscopic transvesical approach for vesicovaginal fistula repair. J Minim Invasive Gynecol. 2013;20:334.

    Article  Google Scholar 

  20. 20.

    Hemal AK, Kumar R, Nabi G. Post-cesarean cervicovesical fistula: technique of laparoscopic repair. J Urol. 2001;165:1167–8.

    CAS  Article  Google Scholar 

  21. 21.

    Das Mahapatra P, Bhattacharyya P. Laparoscopic intraperitoneal repair of high-up urinary bladder fistula: a review of 12 cases. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:635–9.

    Article  Google Scholar 

  22. 22.

    Occhino JA, Hokenstad ED, Linder BJ. Robot-assisted vesicovaginal fistula repair via a transvesical approach. Int Urogynecol J. 2018;30(2):327–9. https://doi.org/10.1007/s00192-018-3843-8.

  23. 23.

    Hemal AK, Sharma N, Mukherjee S. Robotic repair of complex vesicouterine fistula with and without hysterectomy. Urol Int. 2009;82:411–5.

    Article  Google Scholar 

  24. 24.

    Miklos JR, Moore RD, Chinthakanan O. Laparoscopic and robotic-assisted vesicovaginal fistula repair: a systematic review of the literature. J Minim Invasive Gynecol. 2015;22(5):727–36.

  25. 25.

    Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, et al. Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol. 2011;59:26–45.

    Article  Google Scholar 

  26. 26.

    Tracy CR, Raman JD, Cadeddu JA, Rane A. Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol. 2008;5:561–8.

    Article  Google Scholar 

  27. 27.

    O’Conor VJ Jr. Review of experience with vesicovaginal fistula repair. J Urol. 1980;123:367–9.

    Article  Google Scholar 

  28. 28.

    Aminsharifi A. Minimally invasive management of concomitant vesicovaginal and ureterovaginal fistulas after transabdominal hysterectomy: laparoscopic fistula repair with ureteroneocystostomy using Boari flap. J Minim Invasive Gynecol. 2018;25(1):17–8. https://doi.org/10.1016/j.jmig.2017.04.013.

    Article  PubMed  Google Scholar 

  29. 29.

    Ramalingam M, Senthil K, Venkatesh V. Laparoscopic repair of ureterovaginal fistula: successful outcome by laparoscopic ureteral reimplantation. J Endourol. 2005;19(10):1174–6.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mostafa Elmissiry.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Abdel-Karim, A., Elmissiry, M., Moussa, A. et al. Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience. Int Urogynecol J 31, 1357–1362 (2020). https://doi.org/10.1007/s00192-019-04002-y

Download citation

Keywords

  • Laparoscopy
  • Genitourinary fistula
  • Repair