Effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula

Abstract

Aim: Vesicovaginal fistula (VVF) is a social and psychological problem for the female population, causing urinary incontinence and foul-smelling urine. Open, laparoscopic, robotic, and various minimally invasive techniques have been described for the treatment of VVF. In this study, we presented the effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula (TBSF), a novel, minimally invasive technique which we had previously described.
Methods: This surgical case series included 9 patients with VVF of <1 cm located away from ureteral orifices who underwent TBSF from July 2015 to December 2019. The fistula tract was sealed transvesicoscopically with a bipolar vessel sealer. All patients were informed about the modified surgical procedure prior to the operation.
Results: The mean age of the patients was 47.2 (4.6) years. The mean fistula diameter was 6.6 (1.2) mm. The mean operation time was 41 (9.7) minutes. The hospital stay was 1 day in all cases. After catheter removal at 3 weeks, 8 (89 %) patients remained dry while one (11%) patient experienced continuous incontinence.
Conclusion: Transvesicoscopic bipolar sealing of vesicovaginal fistula is a simple and safe procedure to perform for small VVF, has a short learning curve and operative time, and results in reduced blood loss and morbidity, brief hospital stay and improved cosmesis.

Keywords

• Vesicovaginal fistula,Sealing,Bipolar,Transvesicoscopic,Laparoscopic

Vezikovajinal fistülün transvezikoskopik olarak bipolar mühürlenmesinin etkinliği ve ilk sonuçları

Öz

Amaç: Vezikovajinal fistül (VVF), idrar kaçırma ve idrar kokusu nedeniyle, kadınlar için sosyal ve psikolojik bir problemdir. VVF tedavisi için açık, laparoskopik, robotik ve çeşitli minimal invaziv tedavi seçenekleri tanımlanmıştır. Bu çalışmada, daha önce tarif ettiğimiz yeni bir minimal invaziv teknik olan vezikovajinal fistülün transvesikoskopik yolla bipolar mühürlenmesinin etkinliğini ve ilk sonuçlarını sunduk.
Yöntemler: Cerrahi olgu serisi olarak planlanan bu çalışmada, Temmuz 2015-Aralık 2019 tarihleri arasında, üreter orifislerinden uzak yerleşimli ve çapı 1 cm'den küçük vezikovajinal fistülü olan, 9 hastaya transvezikoskopik olarak bipolar damar mühürleme cihazı kullanılarak vezikovajinal fistül mühürleme işlemi gerçekleştirildi. Tüm hastalar ameliyat öncesi modifiye cerrahi prosedür hakkında bilgilendirildi.
Bulgular: Hastaların ortalama yaşı 47,2 (4,6) yıldı. Ortalama fistül çapı 6,6 (1,2) milimetre, ortalama ameliyat süresi 41 (9,7) dakikaydı. Tüm hastalarda hastanede kalış süresi 1 gündü. 3. haftada kateter çıkarıldıktan sonra 8 (%89) hasta kontinan olup, bir (%11) hastada nüks izlendi.
Sonuç: Vezikovajinal fistülün transvesicoskopik yolla bipolar mühürlenmesi; kısa öğrenme eğrisi ve ameliyat süresi, azalmış kan kaybı ve morbidite oranı, kısa hastanede kalış süresi ve iyi kozmetik sonuçları ile küçük fistüller için uygulaması kolay ve güvenli bir prosedürdür.

Anahtar Kelimeler

• Vezikovajinal fistül,Mühürleme,Bipolar,Transvezikoskopik,Laparoskopik

Kaynakça

1. 1. Kochakarn W, Pummangura W. A new dimension in vesicovaginal fistula management: an 8-year experience at Ramathibodi hospital. Asian J Surg. 2007;30(4):267-71. doi: 10.1016/S1015-9584(08)60037-8.
2. 2. Bai SW, Huh EH, Jung DJ, Park JH, Rha KH, Kim SK, et al. Urinary tract injuries during pelvic surgery: incidence rates and predisposing factors. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):360-4. doi: 10.1007/s00192-005-0015-4.
3. 3. Miller EA, Webster GD. Current management of vesicovaginal fistulae. Curr Opin Urol. 2001;11(4):417-21. doi: 10.1097/00042307-200107000-00014.
4. 4. Kumar A, Goyal NK, Das SK, Trivedi S, Dwivedi US, Singh PB. Our experience with genitourinary fistulae. Urol Int. 2009;82(4):404-10. doi: 10.1159/000218528.
5. 5. Hilton P, Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years' experience in southeast Nigeria. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(4):189-94. doi: 10.1007/bf01901602.
6. 6. Akkoç A, Aydın C, Uçar M, Şentürk AB, Topçuoğlu M, Metin A. Transvesicoscopic Bipolar Sealing of Vesicovaginal Fistula. J Endourol Case Rep. 2018; 4(1):94-6. doi: 10.1089/cren.2018.0013.
7. 7. Nezhat CH, Nezhat F, Nezhat C, Rottenberg H. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol. 1994;83(5 Pt 2):899-901.
8. 8. Shah SJ. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2009;23(7):1135-7. doi: 10.1089/end.2009.0080.

9. 9. Gözen AS, Teber D, Canda AE, Rassweiler J. Transperitoneal laparoscopic repair of iatrogenic vesicovaginal fistulas: Heilbronn experience and review of the literature. J Endourol. 2009;23(3):475-9. doi: 10.1089/end.2008.0236.
10. 10. Tiong HY, Shim T, Lee YM, Tan JK. Laparoscopic repair of vesicovaginal fistula.Int Urol Nephrol. 2007;39(4):1085-90. doi: 10.1007/s11255-006-9168-4.
11. 11. Wong C, Lam PN, Lucente VR. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. J Endourol. 2006;20(4):240-3. doi: 10.1089/end.2006.20.240.
12. 12. Shah SJ. Role of day care vesicovaginal fistula fulguration in small vesicovaginal fistula. J Endourol. 2010;24(10):1659-60. doi: 10.1089/end.2009.0557.
13. 13. Aycinena JF. Small vesicovaginal fistula. Urology. 1977;9(5):543-5. doi: 10.1016/0090-4295(77)90248-5.
14. 14. Chekan EG, Davison MA, Singleton DW, Mennone JZ, Hinoul P. Consistency and sealing of advanced bipolar tissue sealers. Med Devices (Auckl). 2015;8:193-9. doi: 10.2147/MDER.S79642.
15. 15. Lyons SD, Law KS. Laparoscopic vessel sealing technologies. J Minim Invasive Gynecol. 2013;20(3):301-7. doi: 10.1016/j.jmig.2013.02.012.
16. 16. Bragayrac LA, Azhar RA, Fernandez G, Cabrera M, Saenz E, Machuca V, et al. Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: a case series. Int Braz J Urol. 2014;40(6):810-5. doi: 10.1590/S1677-5538.IBJU.2014.06.12.
17. 17. Pietersma CS, Schreuder HW, Kooistra A, Koops SE. Robotic-assisted laparoscopic repair of a vesicovaginal fistula: a time-consuming novelty or an effective tool?. BMJ Case Rep. 2014; pii: bcr2014204119. doi: 10.1136/bcr-2014-204119.
18. 18. Singh V, Sinha RJ, Mehrotra S, Gupta DK, Gupta S. Transperitoneal transvesical laparoscopic repair of vesicovaginal fistulae: experience of a tertiary care centre in northern India. Curr Urol. 2013;7(2):75-82. doi: 10.1159/000356253.
19. 19. Gupta NP, Mishra S, Hemal AK, Mishra A, Seth A, Dogra PN. Comparative analysis of outcome between open and robotic surgical repair of recurrent supra-trigonal vesico-vaginal fistula. J Endourol. 2010;24(11):1779-82. doi: 10.1089/end.2010.0049.
20. 20. Wahab F, Nasir A, Manan F. Outcome of VVF repair without omental interposition. J Pak Med Assoc. 2016;66(5):590-2.
21. 21. Lee JH, Choi JS, Lee KW, Han JS, Choi PC, Hoh JK. Immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula developing after total abdominal hysterectomy. JSLS. 2010;14(2):187-91. doi: 10.4293/108680810X12785289143918.
22. 22. Stovsky MD, Ignatoff JM, Blum MD, Nanninga JB, O'Conor VJ, Kursh ED. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol. 1994;152(5 Pt 1):1443-4. doi: 10.1016/s0022-5347(17)32441-2.
23. 23. Falk HC, Orkin LA. Nonsurgical closure of vesicovaginal fistulas. Obstet Gynecol. 1957;9(5):538-41.
24. 24. Shah SJ. Role of day care vesicovaginal fistula fulguration in small vesicovaginal fistula. J Endourol. 2010;24(10):1659-60. doi: 10.1089/end.2009.0557.
25. 25. Karande VC. LigaSure™ 5-mm Blunt Tip Laparoscopic Instrument. J Obstet Gynaecol India. 2015;65(5):350-2. doi: 10.1007/s13224-015-0745-2.