Abstract
Over the past 20 years, the discussion concerning vesicovaginal fistula (VVF) repair has evolved from strictly transabdominal/transvaginal to including minimally invasive surgeries. The original natural orifice approach through the vagina allows for VVF repair with decreased morbidity and minimal convalescence with success rates upwards of 90 %. For surgeries that involve a narrowed/stenotic vagina or a need for a concomitant abdominal procedure, transadominal surgery can be performed by laparoscopic or robot-assisted laparoscopic approaches. Success rates in large series are upwards of 86 %. Difficulties such as an increased learning curve and vesicovaginal plane dissection have been overcome with innovations such as the robotic platform and cutting to the light with vaginoscopy. While still in its infancy in VVF repair, single site surgery has also been utilized with reasonable success. Although minimally invasive surgery offers numerous advantages, the most successful approach will still be the surgery with which the VVF surgeon is most familiar.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hilton P, Cromwell DA. The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service--a retrospective cohort study examining patterns of care between 2000 and 2008. BJOG. 2012;119(12):1447–54.
•• Eilber KS, Kavaler E, Rodriguez LV, et al. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169(3):1033–6. Contemporary retrospective review of 207 patients who underwent transvaginal VVF repair with the majority of patients undergoing a peritoneal inlay flap.
Gettman MT, Lotan Y, Napper CA, Cadeddu JA. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology. 2002;59(3):446–50.
Singh V, Sinha RJ, Sankhwar SN, et al. Transvaginal repair of complex and complicated vesicovaginal fistulae. Int J Gynaecol Obstet. 2011;114(1):51–5.
Wang Y, Hadley HR. Nondelayed transvaginal repair of high lying vesicovaginal fistula. J Urol. 1990;144(1):34–6.
Angioli R, Penalver M, Muzii L, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol. 2003;48(3):295–304.
Leng WW, Amundsen CL, McGuire EJ. Management of female genitourinary fistulas: transvesical or transvaginal approach? J Urol. 1998;160(6 Pt 1):1995–9.
Chibber PJ, Shah HN, Jain P. Laparoscopic O'Conor's repair for vesico-vaginal and vesico-uterine fistulae. BJU Int. 2005;96(1):183–6.
Sotelo R, Mariano MB, Garcia-Segui A, et al. Laparoscopic repair of vesicovaginal fistula. J Urol. 2005;173(5):1615–8.
Das Mahapatra P, Bhattacharyya P. Laparoscopic intraperitoneal repair of high-up urinary bladder fistula: a review of 12 cases. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(6):635–9.
Nagraj HK, Kishore TA, Nagalaksmi S. Early laparoscopic repair for supratrigonal vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(7):759–62.
Shah SJ. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2009;23(7):1135–7.
Abdel-Karim AM, Mousa A, Hasouna M, Elsalmy S. Laparoscopic transperitoneal extravesical repair of vesicovaginal fistula. Int Urogynecol J. 2011;22(6):693–7.
Zhang Q, Ye Z, Liu F, et al. Laparoscopic transabdominal transvesical repair of supratrigonal vesicovaginal fistula. Int Urogynecol J. 2013;24(2):337–42.
Nezhat CH, Nezhat F, Nezhat C, Rottenberg H. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. 1994;83(5 Pt 2):899–901.
Rizvi SJ, Gupta R, Patel S, et al. Modified laparoscopic abdominal vesico-vaginal fistula repair–"Mini-O'Conor" vesicotomy. J Laparoendosc Adv Surg Tech A. 2010;20(1):13–5.
Otsuka RA, Amaro JL, Tanaka MT, et al. Laparoscopic repair of vesicovaginal fistula. J Endourol. 2008;22(3):525–7.
Miklos JR, Sobolewski C, Lucente V. Laparoscopic management of recurrent vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(2):116–7.
Wong C, Lam PN, Lucente VR. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2006;20(4):240–3. discussion 243.
Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153(4):1110–2. discussion 1112–3.
Collins CG, Pent D, Jones FB. Results of early repair of vesicovaginal fistula with preliminary cortisone treatment. Am J Obstet Gynecol. 1960;80:1005–12.
O'Conor Jr VJ. Review of experience with vesicovaginal fistula repair. J Urol. 1980;123(3):367–9.
Lee JH, Choi JS, Lee KW, et al. Immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula developing after total abdominal hysterectomy. JSLS. 2010;14(2):187–91.
von Theobald P, Hamel P, Febbraro W. Laparoscopic repair of a vesicovaginal fistula using an omental J flap. Br J Obstet Gynaecol. 1998;105(11):1216–8.
Gozen AS, Teber D, Canda AE, Rassweiler J. Transperitoneal laparoscopic repair of iatrogenic vesicovaginal fistulas: heilbronn experience and review of the literature. J Endourol. 2009;23(3):475–9.
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(3):378–80.
Kurz M, Horstmann M, John H. Robot-assisted laparoscopic repair of high vesicovaginal fistulae with peritoneal flap inlay. Eur Urol. 2012;61(1):229–30.
Hemal AK, Kolla SB, Wadhwa P. Robotic reconstruction for recurrent supratrigonal vesicovaginal fistulas. J Urol. 2008;180(3):981–5.
Raz S, Bregg KJ, Nitti VW, Sussman E. Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol. 1993;150(1):56–9.
• Melamud O, Eichel L, Turbow B, Shanberg A. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. 2005;65(1):163–6. The first case report published on robot-assisted laparoscopic VVF repair. No recurrence was noted in the patient after 16 weeks.
Erdogru T, Sanli A, Celik O, Baykara M. Laparoscopic transvesical repair of recurrent vesicovaginal fistula using with fleece-bound sealing system. Arch Gynecol Obstet. 2008;277(5):461–4.
Evans DH, Madjar S, Politano VA, et al. Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology. 2001;57(4):670–4.
Goyal NK, Dwivedi US, Vyas N, et al. A decade's experience with vesicovaginal fistula in India. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(1):39–42.
Miklos JR, Moore RD. Failed omental flap vesicovaginal fistula repair subsequently repaired laparoscopically without an omental flap. Female Pelvic Med Reconstr Surg. 2012;18(6):372–3.
Miklos JR, Moore RD. Vesicovaginal fistula failing multiple surgical attempts salvaged laparoscopically without an interposition omental flap. J Minim Invasive Gynecol. 2012;19(6):794–7.
O'Conor VJ, Sokol JK. Vesicovaginal fistula from the standpoint of the urologist. J Urol. 1951;66(4):579–85.
Garcia-Segui A. Laparoscopic repair of vesico-vaginal fistula without intentional cystotomy and guided by vaginal transillumination. Actas Urol Esp. 2012;36(4):252–8.
Ahmed K, Ibrahim A, Wang TT, et al. Assessing the cost effectiveness of robotics in urological surgery - a systematic review. BJU Int. 2012;110(10):1544–56.
Wright JD, Burke WM, Wilde ET, et al. Comparative effectiveness of robotic versus laparoscopic hysterectomy for endometrial cancer. J Clin Oncol. 2012;30(8):783–91.
Wright JD, Herzog TJ, Neugut AI, et al. Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer. Gynecol Oncol. 2012;127(1):11–7.
Judd JP, Siddiqui NY, Barnett JC, et al. Cost-minimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. J Minim Invasive Gynecol. 2010;17(4):493–9.
Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: case series of five patients. Urology. 2006;67(5):970–3.
Rogers AE, Thiel DD, Brisson TE, Petrou SP. Robotic assisted laparoscopic repair of vesico-vaginal fistula: the extravesical approach. Can J Urol. 2012;19(5):6474–6.
• Abdel-Karim AM, Moussa A, Elsalmy S. Laparoendoscopic single-site surgery extravesical repair of vesicovaginal fistula: early experience. Urology. 2011;78(3):567–71. The first series published regarding single-site repair of VVF which included 5 patients with no recurrences at an average of 8 months follow-up.
Ou CS, Huang UC, Tsuang M, Rowbotham R. Laparoscopic repair of vesicovaginal fistula. J Laparoendosc Adv Surg Tech A. 2004;14(1):17–21.
• Gupta NP, Mishra S, Hemal AK, et al. Comparative analysis of outcome between open and robotic surgical repair of recurrent supra-trigonal vesico-vaginal fistula. J Endourol. 2010;24(11):1779–82. Retrospective study evaluating recurrent VVF repair in patients undergoing robot-assisted laparoscopic versus open transabdominal approaches. The study was limited by its restrospective nature and limited sample but is the first to approach a comparison between approaches.
Aycinena JF. Small vesicovaginal fistula. Urology. 1977;9(5):543–5.
Pettersson S, Hedelin H, Jansson I, Teger-Nilsson AC. Fibrin occlusion of a vesicovaginal fistula. Lancet. 1979;1(8122):933.
Morita T, Tokue A. Successful endoscopic closure of radiation induced vesicovaginal fistula with fibrin glue and bovine collagen. J Urol. 1999;162(5):1689.
Stovsky MD, Ignatoff JM, Blum MD, et al. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol. 1994;152(5 Pt 1):1443–4.
Shah SJ. Role of day care vesicovaginal fistula fulguration in small vesicovaginal fistula. J Endourol. 2010;24(10):1659–60.
McKay HA. Vesicovaginal and vesicocutaneous fistulas: transurethral suture cystorrhaphy as a new closure technique. J Urol. 1997;158(4):1513–6.
McKay HA. Vesicovaginal fistula repair: transurethral suture cystorrhaphy as a minimally invasive alternative. J Endourol. 2004;18(5):487–90.
Disclosure
Dr. Christopher F. Tenggardjaja reported no potential conflicts of interest relevant to this article.
Dr. Howard B. Goldman is a section editor for Current Urology Reports. Dr. Goldman received consultancies from Allergan, Medtronic, and Teva. Dr. Goldman received payments for lectures from Astellas, Allergan, and Medtronic.
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Tenggardjaja, C.F., Goldman, H.B. Advances in Minimally Invasive Repair of Vesicovaginal Fistulas. Curr Urol Rep 14, 253–261 (2013). https://doi.org/10.1007/s11934-013-0316-y
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DOI: https://doi.org/10.1007/s11934-013-0316-y