Robot-Assisted Laparoscopic Repair of Supratrigonal Vesicovaginal Fistulae with Peritoneal Flap Inlay

  • Michael Kurz
  • Hubert JohnEmail author


Vesicovaginal fistulae have always been a highly problematic complication. Nowadays, most cases are complications after hysterectomy or obstetric surgery, whereas obstructed labour is the main aetiology in underdeveloped countries. The localisations and dimensions of the fistulae are very different dependent on their aetiology. Obstructed labour leads to necrosis of the anterior vaginal wall and consequently to a lower, urethrovaginal, vesicovaginal or combined fistula. After hysterectomy, we know that fistulae occur in about 1/1800 cases. At a rate of 600,000 hysterectomies in the United States in 2003, we can assume approximately 330 fistulae had to be treated in that year. This makes it not only a social but also an economic issue. These fistulae are usually found to be supratrigonal and sometimes located high on the bladder dome. This fact makes it very demanding or even impossible to operate transvaginally. They occur after inadvertent lesion of the bladder or ureters, operation-site infection or tumourous diseases. The success rate of either repair is between 75 and 97% depending on the method and complexity. Smaller fistulae can be treated by transurethral drainage and sometimes by transurethral coagulation of the bladder wall, depending on their aetiology. However, the long-term results are not very impressive (7–12.5%). A valuable alternative to conservative treatment is the use of fibrin glue. In case of failure, the operative access is still available.


  1. 1.
    Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. 2001;11(4):417–21.CrossRefPubMedGoogle Scholar
  2. 2.
    Wu JM, et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091–5.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    Eilber KS, et al. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169(3):1033–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Ijaiya MA, et al. Vesicovaginal fistula: a review of nigerian experience. West Afr J Med. 2010;29(5):293–8.PubMedGoogle Scholar
  6. 6.
    Hilton P, Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years’ experience in southeast Nigeria. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(4):189–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Hilton P. Vesico-vaginal fistula: new perspectives. Curr Opin Obstet Gynecol. 2001;13(5):513–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Kanaoka Y, et al. Vesicovaginal fistula treated with fibrin glue. Int J Gynaecol Obstet. 2001;73(2):147–9.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    Raz S, et al. Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol. 1993;150(1):56–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: an update. Indian J Urol. 2007;23(2):187–91.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72(3 Pt 1):313–9.PubMedGoogle Scholar
  14. 14.
    Rizvi SJ, et al. Modified laparoscopic abdominal vesico-vaginal fistula repair–“Mini-O’Conor” vesicotomy. J Laparoendosc Adv Surg Tech A. 2010;20(1):13–5.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    Nezhat CH, et al. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. 1994;83(5 Pt 2):899–901.PubMedGoogle Scholar
  17. 17.
    Wong C, Lam PN, Lucente VR. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2006;20(4):240–3; discussion 243.Google Scholar
  18. 18.
    Sotelo R, et al. Laparoscopic repair of vesicovaginal fistula. J Urol. 2005;173(5):1615–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Tiong HY, et al. Laparoscopic repair of vesicovaginal fistula. Int Urol Nephrol. 2007;39(4):1085–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Otsuka RA, et al. Laparoscopic repair of vesicovaginal fistula. J Endourol. 2008;22(3):525–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Porpiglia F, et al. Laparoscopic vesico-vaginal fistula repair: our experience and review of the literature. Surg Laparosc Endosc Percutan Tech. 2009;19(5):410–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Ou CS, et al. Laparoscopic repair of vesicovaginal fistula. J Laparoendosc Adv Surg Tech A. 2004;14(1):17–21.CrossRefPubMedGoogle Scholar
  23. 23.
    Abdel-Karim AM, et al. Laparoscopic transperitoneal extravesical repair of vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 2011;22(6):693–7.CrossRefGoogle Scholar
  24. 24.
    Gozen AS, et al. Transperitoneal laparoscopic repair of iatrogenic vesicovaginal fistulas: Heilbronn experience and review of the literature. J Endourol. 2009;23(3):475–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Erdogru T, et al. Laparoscopic transvesical repair of recurrent vesicovaginal fistula using with fleece-bound sealing system. Arch Gynecol Obstet. 2008;277(5):461–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Miklos JR, Sobolewski C, Lucente V. Laparoscopic management of recurrent vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(2):116–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Hemal AK, Kumar R, Nabi G. Post-cesarean cervicovesical fistula: technique of laparoscopic repair. J Urol. 2001;165(4):1167–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Melamud O, et al. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. 2005;65(1):163–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: case series of five patients. Urology. 2006;67(5):970–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Hemal AK, Kolla SB, Wadhwa P. Robotic reconstruction for recurrent supratrigonal vesicovaginal fistulas. J Urol. 2008;180(3):981–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Schimpf MO, et al. Vesicovaginal fistula repair without intentional cystotomy using the laparoscopic robotic approach: a case report. JSLS. 2007;11(3):378–80.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Engel N, John H. Laparoscopic robot assisted vesico-vaginal fistula repair with peritoneal flap inlay. J Urol. 2008;179(suppl 4):666.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of UrologyKantonsspital WinterthurWinterthurSwitzerland

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