The first laparoscopic vesicovaginal fistula repair in Iran

Abstract

Background: Vesicovaginal fistula (VVF) is the most common acquired fistula of the urinary system. Different surgical techniques exist, but having several advantages make laparoscopy as a favorable method. According to the recent data, we have performed the first laparoscopic repair of VVF in Iran. Case report: A 19-year-old (G1P1) woman, referred to our center, complaining from continuous urinary incontinence from 7 months ago. She developed continuous wetting after her first cesarean section, performed 7 months ago. Methylene blue dye test, was positive for VVF and voiding cystourethrogram (VCUG) confirmed the diagnosis. Cystoscopy revealed the exact location of fistula in the bladder wall. Patient underwent laparoscopic VVF repair using transperitoneal transvesical approach in the supine position. Patient did not have any urinary leakage during hospitalization and discharged with urethral indwelling catheter at fourth day after the operation. Voiding cystourethrogram was done after 2 weeks, and it was normal without any extravasations. Discussion: Dense pelvic adhesions and/or inflammation from prior abdominal surgery can make this approach less desirable in some patients. Furthermore, intracorporeal laparoscopic suturing requirement for VVF repair is an advanced skill many surgeons lack. We used transabdominally transvesical laparoscopic method and, according to the literature review, this is the first case of VVF laparoscopic surgery performed in Iran. ط¢آ© 2014, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.