Gözen Ali Serdar, Teber Dogu, Canda Abdullah Erdem, Rassweiler Jens
Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Germany.
J Endourol. 2009 Mar;23(3):475-9. doi: 10.1089/end.2008.0236.
Vesicovaginal fistula (VVF) continues to be a distressing problem in urogynecology. Laparoscopy has become increasingly popular in the field of reconstructive urologic surgery. We describe our technique of laparoscopic VVF repair for iatrogenic VVFs, discuss our technique and outcomes, and review the related literature.
After hysterectomy for a benign condition, an iatrogenic VVF developed in three women (41, 48, and 34 years old, respectively) that persisted despite conservative therapy. Preoperative urethrocystoscopy demonstrated supratrigonal VVFs. Laparoscopic surgery was performed for the three patients after 3, 8, and 4 months of the previous abdominal operations. Patients were placed in a deflected supine position, and a transperitoneal five-port approach was used. The bladder was bivalved, and the fistula tract was excised. The fistulous tract was successfully repaired by closing the vagina and bladder separately. An interposing peritoneal flap was placed and fixed between the bladder and vagina.
The patients recovered uneventfully and were discharged from the hospital after 4, 9, and 5 days, respectively. Retrograde cystography on postoperative day 10 revealed no contrast leakage via the vagina. The urethral catheters were removed on the same day. After 30, 17, and 14 months of follow up, respectively, the patients were voiding without any urine leakage.
Laparoscopic repair can be applied effectively in the management of VVFs. The approach is safe and provides all advantages of minimally invasive surgery. Shorter hospital stay and shorter recovery time have a positive effect on the patients' well being.
膀胱阴道瘘（VVF）仍是女性泌尿外科中一个令人苦恼的问题。腹腔镜检查在重建泌尿外科手术领域越来越受欢迎。我们描述了针对医源性VVF的腹腔镜VVF修复技术，讨论了我们的技术和结果，并回顾了相关文献。
在因良性疾病行子宫切除术后，三名女性（分别为41岁、48岁和34岁）出现医源性VVF，尽管进行了保守治疗仍持续存在。术前尿道膀胱镜检查显示为膀胱三角区上方的VVF。在先前腹部手术后3、8和4个月，对这三名患者进行了腹腔镜手术。患者取偏斜仰卧位，采用经腹五孔法。将膀胱切开，切除瘘管。通过分别关闭阴道和膀胱成功修复瘘管。在膀胱和阴道之间放置并固定一块腹膜瓣。
患者恢复顺利，分别于术后4、9和5天出院。术后第10天逆行膀胱造影显示无造影剂经阴道漏出。同日拔除尿道导管。分别随访30、17和14个月后，患者排尿时无任何尿漏。
腹腔镜修复可有效应用于VVF的治疗。该方法安全，具有微创手术的所有优点。住院时间缩短和恢复时间缩短对患者的健康有积极影响。
