Transvesical versus extravesical approach to laparoscopic posthysterectomy vesicovaginal fistula repair: A retrospective study from two medical centers.
Peng Zhou, Wen Deng, Junhua Li, Huixian Pan, Yanbin Wang, Chen Song, Weipeng Liu, Bin Fu
Author Information
Peng Zhou: Department of Urology, Third Hospital of Hangzhou, Zhejiang, China.
Wen Deng: Department of Urology, Nanchang University, Nanchang, Jiangxi, China.
Junhua Li: Department of Urology, Third Hospital of Hangzhou, Zhejiang, China.
Huixian Pan: Department of Urology, Third Hospital of Hangzhou, Zhejiang, China.
Yanbin Wang: Department of Urology, Third Hospital of Hangzhou, Zhejiang, China.
Chen Song: Department of Urology, Third Hospital of Hangzhou, Zhejiang, China.
Weipeng Liu: Department of Urology, Nanchang University, Nanchang, Jiangxi, China.
Bin Fu: Department of Urology, Nanchang University, Nanchang, Jiangxi, China. ORCID
BACKGROUND: The controversy on the best surgical approach for vesicovaginal fistula (VVF) repair remains due to the scarcity of high-level evidences. We aim to analyze the efficacy and safety of the laparoscopic transvesical (LT) and laparoscopic extravesical (LE) approaches to posthysterectomy VVF (PH-VVF). METHODS: Data of 64 patients with PH-VVFs who were laparoscopicly treated in the First Affiliated Hospital of Nanchang University and the Hangzhou Third Hospital from January 2011 to November 2019 were retrospectively collected. The operative time (OT), estimated bleeding volume (EBV), postoperative bladder function and complications, hospital stay length (HSL), surgery success rate, and recurrence were compared between the two groups. RESULTS: In all, there were no significant differences in baseline characteristics between those two arms. Both approaches were successfully performed without open conversion in either group. The LT group was significantly corrected with a shorter mean OT than the LE group (p < 0.001), regardless of the fistula's position. No significant differences existed in the mean EBV and HSL between the two interventions (p = 0.136 and p = 0.210, respectively). The tendency of postoperative complications and success rates of surgery were also comparable in both groups. The patients in the LT group had similar bladder functions to those in LE group. The recurrence occurred in one patient in each arm during the follow-up periods of 12-36 months. CONCLUSIONS: The LT approach is significantly related to a shorter OT than the LE approach without compromising the safety and success rates in repairing PH-VVF.
Randazzo M , Lengauer L , Rochat CH , et al. Best practices in robotic-assisted repair of vesicovaginal fistula: a consensus report from the european association of urology robotic urology section scientific working group for reconstructive urology. Eur Urol. 2020;78(3):432-442.
Chapple C , Turner-Warwick R . Vesico-vaginal fistula. BJU Int. 2005;95(1):193-214.
Malik MA , Sohail M , Malik MT , Khalid N , Akram A . Changing trends in the etiology and management of vesicovaginal fistula. Int J Urol. 2018;25(1):25-29.
Ghosh B , Wats V , Pal DK . Comparative analysis of outcome between laparoscopic versus open surgical repair for vesico-vaginal fistula. Obstet Gynecol Sci. 2016;59(6):525-529.
Sachdev PS , Hassan N , Abbasi RM , Das CM . Genito-urinary fistula: a major morbidity in developing countries. J Ayub Med Coll Abbottabad. 2009;21(2):8-11.
Fujisaki A , Kinjo M , Shimoinaba M , Honda S , Yoshimura Y . An evaluation of the impact of post-hysterectomy vesicovaginal fistula repair on the mental health of patients in a developed country. Int J Urogynecol. 2020;31(7):1371-1375.
Hillary CJ , Osman NI , Hilton P , Chapple CR . The aetiology, treatment, and outcome of urogenital fistulae managed in well- and low-resourced countries: a systematic review. Eur Urol. 2016;70(3):478-492.
Lee D , Zimmern P . Vaginal approach to vesicovaginal fistula. Urol Clin North Am. 2019;46(1):123-133.
Ramphal SR . Laparoscopic approach to vesicovaginal fistulae. Best Pract Res Clin Obstet Gynaecol. 2019;54:49-60.
Watts KL , Ho R , Ghavamian R , Abraham N . Robot-assisted extravesical vesicovaginal fistula repair utilizing laparoscopically mobilized omental flap interposition. Int J Urogynecol. 2017;28(4):641-644.
Nezhat CH , Nezhat F , Nezhat C , Rottenberg H . Laparoscopic repair of a vesicovaginal fistula: a case report. Obstetrics and Gynecol. 1994;83(5 Pt 2):899-901.
Miklos JR , Moore RD . Laparoscopic extravesical vesicovaginal fistula repair: our technique and 15-year experience. Int J Urogynecol. 2015;26(3):441-446.
Miklos JR , Moore RD , Chinthakanan O . Laparoscopic and robotic-assisted vesicovaginal fistula repair: a systematic review of the literature. J Minim Invasive Gynecol. 2015;22(5):727-736.
Mellano EM , Tarnay CM . Management of genitourinary fistula. Curr Opin Obstet Gynecol. 2014;26(5):415-423.
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):1216-1218.
Miklos JR , Sobolewski C , Lucente V . Laparoscopic management of recurrent vesicovaginal fistula. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(2):116-117.
Xiong Y , Tang Y , Huang F , Liu L , Zhang X . Transperitoneal laparoscopic repair of vesicovaginal fistula for patients with supratrigonal fistula: comparison with open transperitoneal technique. Int J Urogynecol. 2016;27(9):1415-1422.
Bora GS , Singh S , Mavuduru RS , et al. Robot-assisted vesicovaginal fistula repair: a safe and feasible technique. Int J Urogynecol. 2017;28(6):957-962.
Hillary CJ , Chapple CR . The choice of surgical approach in the treatment of vesico-vaginal fistulae. Asian J Urol. 2018;5(3):155-159.
Marks P , Kluth LA , Lang IJ , Fisch M . [Vesicovaginal fistulas: diagnosis and surgical management]. Urologe A. 2020;59(4):432-441.
Abdel-Karim AM , Mousa A , Hasouna M , Elsalmy S . Laparoscopic transperitoneal extravesical repair of vesicovaginal fistula. Int J Urogynecol. 2011;22(6):693-697.
Tenggardjaja CF , Goldman HB. Advances in minimally invasive repair of vesicovaginal fistulas. Curr Urol Rep. 2013;14(3):253-261.
Zhou X , Fu B , Zhang C , et al. Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes. BJU Int. 2020;126(2):300-308.
