A fistula is an abnormal communication between two epithelial surfaces (1). A vesicovaginal fistula (VVF) results in a continuous urinary incontinence (2). This condition brings a severe deterioration in middle-aged womens quality of life (3). Its incidence is underestimated given the associated social stigma (4). Our objective is to describe clinical results, incontinence rates and complications in VF repair with a natural orifice transluminal transurethral endoscopic surgical technique (NOTES). This due to the difficulty in the access through the abdominal or vaginal approach sometimes.METHODS: Previously we presented a case in video of a transurethral VF repair with good outcomes ( 5), now we present a series of 24 patients taken to VF repair with NOTES technique from 2013 -2021. Patients taken to VVF, Vesicoperitoneal (VPF) and vesicoenteral (VEF) closure were included. The surgical procedure consists in a transurethral approach, with the use of a resectoscope and Collins loop, the VF hole in the bladder wall is circumcised, then a continuous suture is performed with a bio spiculated suture introduced by the urethral meatus, minor variations between male and female's techniques are exposed. The surgical technique, complications, outcomes, and clinical follow-up of the patients are described.RESULTS: A total of 24 patients were included, 95.8% female. The median age was 42 years. 79.1% had VVF. 54.1% had complex VF. The median surgical time was 55 and 77 minutes for simple and complex fistulas, respectively. The rate of intra-surgical complications was anesthesia related in 4.2%. There were no complications ! III on the Clavien Dindo scale. 41.6% of the procedures were ambulatory. All patients were released with anticholinergics and bladder catheterizing. 9 of 10 patients with simple VVF reported postoperative clinical improvement. 9 of 13 patients with complex VF had complete resolution of incontinence after removal of the catheter. The median follow-up was 10 months.CONCLUSIONS: NOTES is a minimally invasive technique useful for the initial approach of patients with a VF. It is a reproducible, short-time and potentially ambulatory technique. This approach favors the closure of VVF, VPF and even VEF in non-oncological, oncological and irradiated patients, it is a useful option in patients with previous difficult abdominal approaches without the need to perform open bladder or transabdominal surgery. Multicentric prospective studies are needed for further conclusions.
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