Simple and effective: transvaginal vesico-vaginal fistula repair with a modified Latzko technique

Endoscopic Laser Dissection Combined with Laparoscopic Pneumovesical Repair of Vesicovaginal Fistula:A Novel Technique and Case Report

OBJECTIVE

To present a novel technique for the repair of vesicovaginal fistula (VVF) in a transgender patient.

METHODS

We present a novel technique that combined endoscopic laser dissection and a transvesical laparoscopic approach for VVF repair in a transmasculine patient who received vaginal colpectomy. A literature review of VVF repair was also conducted.

RESULTS

The patient had an uneventful recovery, and the VVF healed over time.

CONCLUSIONS

Surgical repair of VVF has been described extensively in the literature. Transvaginal and transabdominal laparoscopic approaches are currently the most common techniques for VVF management. However, for transmasculine patients, neither of these methods is ideal due to either a previous history of vaginal colpectomy or the position of the fistula. This case report demonstrates the feasibility of applying a combined endoscopic laser dissection and transvesical laparoscopic approach for VVF repair. More cases are needed to demonstrate the effectiveness and complication rate of this technique in the future.

Suprapubic Transvesical Repair of Vesicovaginal Fistula Using a Homemade Laparoscopic Single-Port Device: Experience of 42 Patients

Aim: Vesicovaginal fistula (VVF) is the most common urogenital acquired fistula, and has remained a scourge and of public health importance. VVF can be repaired by transvaginal approach, transabdominal approach or transvesical approach, but the optimal management is still debated.

Methods: To demonstrate a suprapubic transvesical approach to repair VVFs using a homemade laparoscopic single-port device. A retrospective review of the medical records of 42 consecutive patients who underwent fistula repair for VVF at our center from January 2012 to March 2018 was performed. VVFs were repaired by a suprapubic transvesical approach using a homemade laparoscopic single-port device. Clinical data, perioperative data and outcomes were collected. The primary outcome was VVF successful closure rate, and secondary outcome was perioperative complications.

Results: The mean age of the patients was 44.6 (27–58) yr. The mean follow-up time was 65.6 (32–118) mo. The VVFs were successfully closed in 37 (88.1%) patients after the first surgery, and failure was observed in five patients. Initial failures of all the five patients were cured after a second repair. No major complication occurred as defined by Clavien-Dindo class 2 or greater.

Conclusions: Suprapubic transvesical approach to repair VVFs using a homemade laparoscopic single-port device is a simple, effective, and feasible approach offering ideal results without major complications.

Update on vesicovaginal fistula: A systematic review

Objective: To conduct a systematic review of the literature on vesicovaginal fistula (VVF), including reporting on the aetiology, in both developed and underdeveloped countries; diagnosis; intraoperative prevention; and management.

Methods: We conducted a systematic review of the literature on VVF through the PubMed and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted from 1985 to 2018 in English, using the keywords ‘fistula’ and ‘vesicovaginal fistula’. Prospective studies were preferred; however, retrospective studies and case reports were used when no prospective studies were available. All authors’ extracted relevant data related to the proposed review of VVF and carefully examined collected articles.

Results: In all, 116 relevant articles were identified and 43 articles were included in this systematic review. The outcome of surgical reconstruction was >90%, but the outcome may be suboptimal in radiotherapy (RT)-induced VVFs. Absolute indications for an abdominal approach included: ureteric involvement, the need for concomitant bladder augmentation, severe vaginal stenosis, and an inability to tolerate the dorsal lithotomy position (e.g. due to muscular spasticity). Typically, it was recommended to wait at least 3 months to allow the inflammatory response to subside before definitive surgery. Early fistula repair can be performed in the absence of infection and in patients who have not received pelvic RT.

Conclusion: VVF is rare in developed countries. Surgical treatment is the primary method of repair. The outcome of surgical reconstruction exceeds 90%, but the outcome may be suboptimal in RT-induced VVFs.

Abbreviations: PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RT: radiotherapy; (S)UI: (stress) urinary incontinence; UVF: ureterovaginal fistula; VVF: vesicovaginal fistula