Same problem,different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair—case report |
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Authors: | David Hernndez-Hernndez Miguel ngel Navarro-Galms Brbara Padilla-Fernndez Víctor Javier Ramos-Gutirrez David Manuel Castro-Díaz |
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Institution: | 1.Department of Urology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain;2.Departamento de Cirugía, Universidad de La Laguna, San Cristóbal de La Laguna, Spain |
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Abstract: | Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O’Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder. |
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Keywords: | Vesicovaginal fistula (VVaF) laparoscopic surgical procedure transvesical repair extravesical repair case report |
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