Mediathek

Abstract

Best practices in robotic-assisted repair of vesicovaginal fistula: A consensus report from the ERUS scientific working group for reconstructive urology

M. Randazzo¹, L. Lengauer^1, C.-H. Rochat², A. Ploumidis³, D. Kröpfl⁴, J. Rassweiler⁵, N.M. Buffi⁶, P. Wiklund⁷, A. Mottrie⁸, H. John^9
1Kantonsspital Winterthur, Urologie, Winterthur, Schweiz, ²Clinique Générale Beaulieu, Geneva, Schweiz, ³Athens Medical Center, Athens, Griechenland, ⁴Klinik Essen Mitte, Essen, Deutschland, ⁵SLK Kliniken, Heilbronn, Deutschland, ⁶Humanitas Research Hospital, Milan, Italien, ⁷Icahn School of Medecine at Mount Sinai Health System, New York, Vereinigte Staaten von Amerika, ⁸OLV Hospital, Aalst, Belgien, ⁹Kantonsspital Winterthur, Winterthur, Schweiz

Context: Surgical repair of vesicovaginal fistula (VVF) has been extensively described in the literature for several decades. Advances in robotic repair have been adopted since 2005.
Objective: A consensus review of existing data based on published case series, expert opinion and a survey monkey. Evidence acquistion: This document summarises the consensus group meeting and survey monkey results convened by the European Association of Urology Robotic Urology Section (ERUS) relating to the robotic management of VVF.
Evidence synthesis: Current data underline the successful robotic repair of supratrigonal non-obstetric VVF. The panel recommends the preoperative marking of the fistula by a guidewire or ureteral catheter and in plus the protective ureteral JJ stenting. An extravesical robotic approach provides usually a good anatomic view for adequate and wide dissection of the vesicovaginal space, as well as bladder and vaginal mobilization. Careful sharp dissection of the fistula edges should be performed. The tension free closure of the bladder is of utmost importance. Tissue interposition seems to be beneficial. The success rate of published series reaches often near 100%. An indwelling bladder catheter should be placed for about 10 days postoperatively.
Conclusion: When considering robotic repair for VVF, it is essential to establish the size, number, location and etiology of the VVF. Robotic assistance facilitates dissection of the vesicovaginal space, the harvesting of a well vascularized tissue flap and a tension free closure of the bladder with a low morbidity for the patient operating in the deep preoperated pelvis with delicate anatomical structures.