Abstract
In this chapter, we discuss the robotic handling of urinary fistulas, mainly three types of fistulae: vesicovaginal, ureterovaginal, and rectourinary fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition. Conservative management has been described for this type of fistula, where low success rates (7–12%) have been reported. Surgical management includes open, laparoscopic, as well as robotic surgery. Robotic-assisted laparoscopic vesicovaginal fistula repair is feasible and associated with distinct advantages. Although direct comparisons to an open transabdominal, vaginal, or laparoscopic approach are lacking, preliminary data suggests that this technique is at least as effective. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy. Patients typically present with global and persistent urine leakage through the vagina; this causes patient discomfort, distress, and typically protection is used to stay dry. Several techniques for the management of ureterovaginal fistulae have been described. Initial management is often conservative but typically fails. When conservative and/or endoscopic approaches fail, formal repair with an open, laparoscopic, or robotic approach is warranted. In this chapter, we will describe the surgical technique of robotic-assisted ureterovaginal fistula repair. Rectourinary fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, they most frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectourethral fistulae can also develop following ablative therapies or surgery for benign prostatic hyperplasia, typically between the prostatic urethra and the rectum. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior “racquet-handle” closure of the bladder. Conservative management consisting of urinary diversion, broad spectrum antibiotics, and parenteral nutrition is often initially attempted, but these measures often fail. Timing of repair is often individualized mainly according to the etiology, delay of diagnosis, size of fistula, the first or subsequent repairs, and the general condition of the patient. More than 40 surgical techniques for the management of RUF have been described and there is no data clearly favoring one approach. Transanal, transanorectal, transsphincteric, transabdominal, perineal, and combined approaches are frequently used. Encouraged by our experience in robotic surgery, and having demonstrated feasibility with the laparoscopic approach, we duplicate the fundamental principles of fistula repair with robotic assistance.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. 2001;11:417-421.
Phipps J. Laparoscopic repair of posthysterectomy vesicovaginal fistula. Two case reports. Gynecol Endosc. 1996;5:123-124.
Raz S, Bregg K, Nitti V, Sussman E. Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol. 1993;150:56-59.
Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153:1110-1112.
Raz S. Editorial comment on: early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153:1112-1113.
Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169:1033-1036.
Nezhat CH, Nezhat F, Nezhat C, Rottenberg H. Lapa-roscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol, part 2. 1994;83:899-901.
von Theobald P, Hamel P, Febbraro W. Laparoscopic repair of a vesicovaginal fistula using an omental J flap. Br J Obstet Gynecol. 1998;105:1216-1218.
Miklos JR, Sobolewski C, Lucente V. Laparoscopic management of recurrent vesicovaginal fistula. Int Urogynecol J. 1999;10:116-117.
Nabi G, Hemal AK. Laparoscopic repair of vesicovaginal fistula and right nephrectomy for nonfunctioning kidney in a single session. J Endourol. 2001;15:801-803.
Ou CS, Huang UC, Tsuang M, Rowbotham R. Laparoscopic repair of vesicovaginal fistula. J Laparoendosc Adv Surg Tech A. 2004;14:17-21.
Sotelo R, Mariano MB, Garcia-Segui A, et al. Laparoscopic repair of vesicovaginal fistula. J Urol. 2005;173:1615-1618.
Chibber PJ, Shah HN, Jain P. Laparoscopic O’Conor’s repair for Vesico-vaginal and Vesico-uterine fistulae. BJU Int. 2005;96(1):183-186.
Melamud O, Eichel L, Turbow B, Shanberg A. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. 2005;65(1):163-166.
Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: case series of 5 patients. Urology. 2006;67:970-973.
Schimpf MO, Morgenstern JH, Tulikangas PK, Wagner JR. Vesicovaginal fistula repair without intentional cystotomy using the laparoscopic robotic approach: a case report. JSLS. 2007;11:378-380.
Gill IS, Zippe CD. Laparoscopic radical prostatectomy: technique. Urol Clin North Am. 2001;28:423-436.
Hosseini SY, Roshan YM, Safarinejad MR. Uretero vaginal fistula after vaginal delivery. J Urol. 1998;160:829.
Selzman AA, Spirnak JP, Kursh ED. The changing management of ureterovaginal fistulas. J Urol. 1995;153:626-628.
Mongiu AK, Helfand BT, Kielb SJ. Ureterovaginal fistula formation after oocyte retrieval. Urology. 2009;73:444. e1-e3.
Patil NN, Mottrie A, Sundaram B, Patel VR. Robotic assisted laparoscopic ureteral reimplantation with Psoas Hitch: a multi-institutional, multinational evaluation. Urology. 2008;72(1):47-50; discussion 50. Epub 2008 Apr 2.
Modi P, Gupta R, Rizvi SJ. Laparoscopic ureteroneocystostomy and Psoas Hitch for post hysterectomy ureterovaginal fistula. J Urol. 2008;180:615-617.
Reddy PK, Evans RM. Laparoscopic ureteroneocystostomy. J Urol. 1994;152(6 pt 1):2057-2059.
Yohannes P, Chiou RK, Pelinkovic D. Pure robot assisted laparoscopic ureteral reimplantation for ureteral stricture disease. Case report. J Endourol. 2003;17(10):891-893.
Rajesh Laungani, Nilesh Patil, Louis S.Krane, Ashok Hemal, Sahabuddin Raja, Hahendra Bhandari, Mani Menon. Robotic-Assited ureterovaginal fistula repair: report of efficacy and feasibility. Journal of laparoendoscopic and advanced surgical techniques. 2008;18(5): 731-734
Naeyer GD, Migem PV, Schatteman P, et al. Pure robot assisted psoas hitch ureteral reimplantation for distal-ureteral stenosis. J Endourol. 2007;21:618-620.
Thomas R, Davis R, Ahuja S. Toward out-patient radical prostatectomy: a cost effective cost management of patients with localized prostate cancer. Br J Urol. 1997;80(suppl 2):261.
Benoit RM, Naslund MJ, Cohen JK. Complications after radical retropubic prostatectomy in the Medicare population. Urology. 2000;56:116-120.
Chrouser K, Leibovich BC, Sweat SD, et al. Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. J Urol. 2005;173:1953-1957.
Badalament RA, Bahn DK, Kim H, et al. Patient-reported complications after cryoablation therapy for prostate cancer. Urology. 1999;54:295-300.
Blandy JP, Singh M. Fistulae involving the adult male urethra. Br J Urol. 1972;44:632.
Al-Ali M, Kashmoula D, Saoud IJ. Experience with 30 posttraumatic rectourethral fistulas: presentation of posterior transsphincteric anterior rectal wall advancement. J Urol. 1997;158:421-424.
Shin P, Foley E, Steers W. Surgical management of rectourinary fistulae. J Am Coll Surg. 2000;191:547-553.
Garofalo TE, Delaney CP, Jones SM, Remzi FH, Fazio VW. Rectal advancement flap repair of rectourethral fistula: a 20-year experience. Dis Colon Rectum. 2003;46:762-769.
Noldus J, Graefen M, Huland H. An “old technique” for a new approach for repair of rectourinary fistulas. J Urol. 1997;157(suppl 4):1547.
Bukowski T, Chakrabarty A, Powell I, Frontera R, Perlmutter A, Montie J. Acquired rectourethral fistula: methods of repair. J Urol. 1995;153:730-733.
Zinman L. Managing complex rectourethral fistulas. Contemp Urol. 2005;17:30-38.
Harpster LE, Rommel FM, Sieber PR, et al. The incidence and management of rectal injury associated with radical prostatectomy in a community based urology practice. J Urol. 1995;154:1435-1438.
Gibbons RP. Radical perineal prostatectomy. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell’s Urology. 7th ed. Philadelphia: Sanders; 1997:2589-2603.
Sotelo R, Garcia A, Yaime H, Rodríguez E, Dubois R, De Andrade R. Laparoscopic rectovesical fistula repair. J Endourol. 2005;19:603-607.
Sotelo R, De Andrade R, Carmona O, et al. Robotic repair of rectovesical fistula resulting from open radical prostatectomy. Urology. 2008;72:1344-1346.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag London Limited
About this chapter
Cite this chapter
Noguera, R.J.S., Cortés, R.G., Richstone, L. (2011). Robotic Surgical Management of Urinary Fistulae. In: Patel, V. (eds) Robotic Urologic Surgery. Springer, London. https://doi.org/10.1007/978-1-84882-800-1_39
Download citation
DOI: https://doi.org/10.1007/978-1-84882-800-1_39
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-84882-799-8
Online ISBN: 978-1-84882-800-1
eBook Packages: MedicineMedicine (R0)