Leos-Acosta C, Morales-Montor J, Vázquez-Ortega L, Castellano-Orozco M, Camarena-Reynoso H, Shuck-Bello C, Hernández-Castellanos V, Pacheco-Gahbler C, Calderón-Ferro F

Language: Spanish
References: 16
Page: 185-189
PDF size: 160.71 Kb.

ABSTRACT

Clinical case: The patient is a 55-year-old woman with a 15-year history of high blood pressure managed with 100 mg oral metoprolol every 12 hours.
Obstetric/gynecologic history: G1 P1 A1 C1. Patient underwent cesarean section 14 years ago. Total abdominal hysterectomy was performed 4 months prior to her admittance to our service. Present illness began with total urinary incontinence in the immediate postoperative period of total abdominal hysterectomy.
Gynecologic examination revealed genitals in accordance with age and sex and vaginal exam identified fibrotic zone at anterior vaginal wall level. Cystoscopy showed the presence of a fistulous opening approximately 4 mm in diameter at the base of the bladder. Colorimetric test was positive and cystography image was suggestive of vesicovaginal fistula (VVF).
Laparoscopic vesicovaginal fistula resection was performed with no complications. Transurethral and ureteral catheters were left in place.
Progression: There was adequate immediate postoperative progression. Cystography was done 3 weeks after surgery with transurethral catheter still in place, showing no evidence of fistula, and so catheter was then removed. At 4-month follow-up there was still no sign of fistula, continence was 100% and there were no signs of urinary tract infection. The patient was urologically asymptomatic.
Discussion: In developed countries the principal cause of VVF is trauma during gynecological procedures. Complications present in 1 out of every 1800 abdominal hysterectomies, making this procedure the principal cause of VVF. Laparoscopic resection was first reported by Nezhat in 1994 and since then 23 cases have been reported in the medical literature.
Conclusions: Laparoscopic approach in VVF is an efficient alternative in relation to open surgery. Surgical principles of adequate exposure, fibrous tissue resection, tension-free repair and efficient bladder drainage are all viable with this approach.

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