CU 54. Intravesical laparoscopic repair of vesicovaginal fistula

Objective: To introduce a new technique to treat vesicovaginal fistula with intravesical laparoscopic repair, and assess the safety and efficacy of this technique.

Methods: 4 female patients of iatronic vesicovaginal fistula were treated with intravesical laparoscopic method between October 2008 and March 2010. The second case ever underwent open surgery repair four months ago. All the fistulae were in posterior wall of bladder, and 0.8, 1.0, 1.2 and 0.5 cm in size respectively. One 10 mm superpubic Trocar and 2.5 mm lateral Trocars were placed in surgery. Carbon dioxide gas was used to distend the bladder.

Results: Four operations were completed successfully. The operative time was 80-140 min, and the blood loss was 50-100 mL. The indwelling catheter was removed after 4 weeks. All the patients were followed up for 1-8 months. 3patients showed no recurrence of fistula and had normal urination. One patient appeared urinary leakage through the vagina again after 1 month.

Conclusions: Intravesical laparoscopic technique is a safe and effective treatment with micro-trauma for iatrogenic vesicovaginal fistula, but more clinical files are needed for further evaluation.