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.

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

“…The epithelial lining layer of the fistula tract is subjected to fulguration using electrocautery to promote fibrosis. (Akkoç and AYDIN 2020)have reported a success rate of 89% utilizing transvesicoscopy bipolar electrofulguration and three weeks of continuous bladder drainage (CBD) in a cohort of nine patients diagnosed with small fistulas (<1 cm in size).…”

“…Consequently, the selection of conservative methodologies is contingent upon the physician's inclination, accompanied by a comprehensive elucidation that surgical measures would be imperative if the non-invasive treatment proves ineffectual (Safan et al, 2009;Rajaian & Kekre, 2012;Akkoç & AYDIN, 2020)…”