A retrovesical approach for the laparoscopic repair of vesicouterine fistulas

Objective To report the initial experience with laparoscopic repair of vesicouterine fistulas (VUFs) at Shiraz University of Medical Sciences, Shiraz, Iran. Methods Between June 2012 and February 2013, 2 patients with a history of multiple cesarean deliveries had a diagnosis of VUF confirmed by cystography and cystoscopy. The fistulas were repaired laparoscopically via a retrovesical approach to minimize manipulation of the bladder. Results The operative times were 160 minutes and 180 minutes. Excellent laparoscopic visualization and magnification together with the presence of a catheter in the fistula tract allowed meticulous dissection in the retrovesical space between the bladder and the uterus, and resection of the fistula tract with minimal manipulation of the bladder, obviating the need for a large cystotomy. A postoperative cystogram at 4 weeks showed complete resolution of the VUF in both patients. There was no recurrence of the fistula and the patients remained symptom-free during the follow-up period. Conclusion Laparoscopic VUF repair with a retrovesical approach is an effective technique with successful outcome. This approach provides excellent exposure to a poorly accessible area in the retrovesical space. Longer follow-up periods are needed to evaluate the likelihood of VUF recurrence with this technique.