Category: Female Urology

VS6-14 - Transvesical laparoendoscopic one-port repair of iatrogenic vesicouterine fistula

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Vesicouterine fistulae (VUF) are the rarest type of urogenital fistulae.  They are usually related to Cesarean delivery.  Various open, laparoscopic and robotic approaches were used for surgical closure of VUF. Mostly, they require bivalving of the bladder. This manoeuvre increases the morbidity of the procedure and lengthens either the operative time or the hospital stay. Because of the limited number of reports on this procedure in the literature, optimal treatment for VUF is an area of active investigation.  Here we present a case of using transvesical laparoendoscopic single-port surgery (T-LESS) for iatrogenic VUF repair.


Methods :

In April 2017, we carried out the T-LESS access on a 42-year old woman, who had undergone Cesarean sections in 2010 and 2013, to close a VUF. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (Tri-Port+) via a 1.5-cm incision made 3 cm above the pubic symphysis. Standard 10-mm optic and straight laparoscopic instruments were used. Two openings of a VUF (3 and 2 mm in diameter) were found, dissected separately, and closed in-layers with running absorbable barbed 2/0 V-Loc sutures. An 18F Foley catheter was left in place for two weeks.


Results : The operation lasted 90 minutes. The blood loss was minimal and no complications were observed. The postoperative period was uneventful. The patient was discharged within 40 hours of surgery. During a one-year follow-up, the patient reported complete remission of symptoms. Laboratory examination results were all within the normal range.


Conclusions :

The T-LESS procedure may be considered as a valuable option for vesicouterine fistula repair because of its minimal invasiveness, short hospital stay and fast recovery time.

Maciej Przudzik

Assistant
Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Olsztyn, Warminsko-Mazurskie, Poland

Marek Roslan

Head of the Department
Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Olsztyn, Warminsko-Mazurskie, Poland

Michał Borowik

Assistant
Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Olsztyn, Warminsko-Mazurskie, Poland

Mirosław Łesiów

Assistant
Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Olsztyn, Warminsko-Mazurskie, Poland

Roman Łesiów

Assistant
Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Olsztyn, Warminsko-Mazurskie, Poland