Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
Department of Urology, Clinique Générale Beaulieu, Geneva, Switzerland.
Eur Urol. 2020 Sep;78(3):432-442. doi: 10.1016/j.eururo.2020.06.029. Epub 2020 Jul 9.
Surgical repair of a vesicovaginal fistula (VVF) has been described extensively in the literature for several decades. Advances in robotic repair have been adopted since 2005.
A consensus review of existing data based on published case series, expert opinion, and a survey monkey.
This document summarizes the consensus group meeting and survey monkey results convened by the European Association of Urology Robotic Urology Section (ERUS) relating to the robotic management of VVF.
Current data underline the successful robotic repair of supratrigonal nonobstetric VVF. The panel recommends preoperative marking of the fistula by a guidewire or ureteral catheter, and placement of a protective ureteral JJ stent. An extravesical robotic approach usually provides a good anatomic view for adequate and wide dissection of the vesicovaginal space, as well as bladder and vaginal mobilization. Careful sharp dissection of fistula edges should be performed. Tension-free closure of the bladder is of utmost importance. Tissue interposition seems to be beneficial. The success rate of published series often reaches near 100%. An indwelling bladder catheter should be placed for about 10 d postoperatively.
When considering robotic repair for VVF, it is essential to establish the size, number, location, and etiology of the VVF. Robotic assistance facilitates dissection of the vesicovaginal space, harvesting of a well-vascularized tissue flap, and a tension-free closure of the bladder with low morbidity for the patient being operated in the deep pelvis with delicate anatomical structures.
Robotic repair of a vesicovaginal fistula can be applied safely with an excellent success rate and very low morbidity. This confirms the use of robotic surgery for vesicovaginal fistula repair, which is recommended in a consensus by the European Association of Urology Robotic Section Scientific Working Group for reconstructive urology.
几十年来，文献中已经广泛描述了治疗膀胱阴道瘘（VVF）的手术修复方法。自 2005 年以来，机器人修复技术得到了应用。
根据已发表的病例系列、专家意见和调查结果，对现有数据进行共识审查。
本文总结了欧洲泌尿外科机器人泌尿外科分会（ERUS）召开的共识小组会议和调查结果，内容涉及机器人治疗 VVF。
目前的数据强调了机器人修复非产科性高位膀胱阴道瘘的成功。该小组建议在术前通过导丝或输尿管导管对瘘管进行标记，并放置保护性输尿管 JJ 支架。经膀胱外机器人入路通常可以提供良好的解剖视图，便于充分广泛地分离膀胱阴道间隙以及膀胱和阴道的游离。应仔细锐性分离瘘管边缘。膀胱无张力闭合至关重要。组织间置似乎有益。发表的系列成功率通常接近 100%。术后应留置膀胱导尿管约 10 天。
在考虑机器人治疗 VVF 时，必须确定 VVF 的大小、数量、位置和病因。机器人辅助有助于分离膀胱阴道间隙、采集血供良好的组织瓣，并在深骨盆中精细解剖结构下对患者进行低并发症的无张力膀胱闭合。
机器人治疗膀胱阴道瘘安全有效，成功率高，并发症低。这证实了机器人手术在膀胱阴道瘘修复中的应用，欧洲泌尿外科机器人分会重建泌尿外科科学工作组推荐使用该技术。
