Transurethral Approach for Vesicovaginal Fistula(VVF) Repair?- A Less Invasive Method with Preliminary Outcome
Chen-Ya Chen1, Sheng-Chen Wen1,2
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 2Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Purpose: Fistulas may be repaired through various methods including transabdominal, transvaginal, and laparoscopic approaches depending on the surgeon’s preference and experience. McKay introduced transurethral repair, a minimally invasive surgical alternative in 2004. We modified the transurethral method by using the offset nephroscope and laparoscopic needle holder, establishing a feasible system that converges viewing, irrigation, light source, and passage of needle-driver into one passage through the urethra. Barbed suture provides more efficient single-handed closure.
Materials and Methods: Three cases presented in this article demonstrate the concept, instrument setting, and successive outcomes of similar patient characteristics.
Results: All three cases received transurethral VVF repair by using the nephroscope and laparoscopic needle holder. The intravesical repair was done by barbed suture. Suprapubic visualization is no longer required in our setting, leaving any wound over the lower abdominal area. All cases received outpatient follow-up for one month, and no urinary leakage was observed. There was no additional surgery required till now.
Conclusion: With the advance of the barbed suture, transurethral repair has become an intuitive, safe, and effective method for relatively small VVF. Our instrument setting as demonstrated provides a feasible system that only requires a daily urosurgery routine. The transurethral approach seems worth trying before other more invasive procedures are considered.