Mp42-18 robot-assisted vesico-vaginal fistula repair: comparison of the extravesical and transvesical techniques

You have accessJournal of UrologyCME1 Apr 2023MP42-18 ROBOT-ASSISTED VESICO-VAGINAL FISTULA REPAIR: COMPARISON OF THE EXTRAVESICAL AND TRANSVESICAL TECHNIQUES Pierre Lecoanet, Thibault Tricard, Anne Mauger De Varennes, Camille Haudebert, Juliette Hascoet, Nicolas Hubert, Imad Bentellis, Branwell Tibi, Christian Saussine, Jacques Hubert, and Benoit Peyronnet Pierre LecoanetPierre Lecoanet More articles by this author , Thibault TricardThibault Tricard More articles by this author , Anne Mauger De VarennesAnne Mauger De Varennes More articles by this author , Camille HaudebertCamille Haudebert More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Nicolas HubertNicolas Hubert More articles by this author , Imad BentellisImad Bentellis More articles by this author , Branwell TibiBranwell Tibi More articles by this author , Christian SaussineChristian Saussine More articles by this author , Jacques HubertJacques Hubert More articles by this author , and Benoit PeyronnetBenoit Peyronnet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic vesico-vaginal fistula repair (R-VVF) was described in 2004 with the aim to minimize the morbidity of the abdominal VVF repair. Almost two decades later, the literature on r-VVF remains scant. The objective of this study was to evaluate the results of R-VVF repaisr and to report complications. METHODS: The charts of all female patients who underwent a R-VVF from March 2007 to December 2021 at four academic institutions were reviewed retrospectively. All surgeons involved had already a robust robotic surgery experience at the beginning experience (>50 cases) but limited experience with VVF repair. All abdominal VVF repair over the study period were performed using a robotic approach. All centers used a vaginal approach in case of easily accessible vaginal fistulous orifice. The decision to use a vaginal or an abdominal approach was not standardized across centers and left at the surgeons’ discretion. The patients’ characteristics, the surgical technique details (iflap interposition vs. not, transvesical versus extravesical approach, excision of fistulous tract vs not) and peri-operative outcomes were recorded. The success of VVF-R was defined as the absence of clinical recurrence. The outcomes of the extravesical vs transvesical techniques were compared. RESULTS: Twenty-two patients were included over the study period. The median age was 43 years (IQR 38-50). The causes of VVF-R were either post-surgical (77.3%), post-obstetrical (18.2%) or post-trauma (4.5%). Fistulas were supratrigonal and trigonal in 18 and 4 cases respectively. The fistulous tract was systematically excised and an interposition flap was used all but two cases (90.9%%). The transvesical and extravesical techniques were used in 13 and 9 cases respectively. The patient andfistula’s characteristics are presented in Table 1. There were more supratrigonal fistula in the extravesical group (100% vs. 69.2%; p=0.11). One intraoperative complication occurred in the extravesical group: an ureteral injury which was immediately sutured (11.1% vs. 0%; p=0.41). The operative time tended to be shorter in the extravesical group (179 vs. 229 minutes; p=0.13). There were only three postoperative complications, all minor: one gross hematuria in the extravesical group (Clavien grade 1), one hematoma requiring blood transfusion and one pyelonephritis in the transvesical group (both Clavien grade 2) (11.1% vs. 15.4%; p=0.99). The length f hospital stay did not differ significantly between the to groups (5.1 vs. 4.1 dys; p=0.56). None of the patients had vesico-vaginal fistula recurrence after a median follow-up of 14 months (IQR 3-21). CONCLUSIONS: The present series, one of the largest R-VVF reported to date, is consistent with the few series already published with a 100% cure rate and excellent perioperative outcomes. Systematic excision of the fistulous tract and the high rate of flap interposition may explain the high success rate. The transvesical and extravesical approach yielded similar outcomes but the transvesical approach may allow to treat more complex fistulas (e.g. infratrigonal). Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e575 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pierre Lecoanet More articles by this author Thibault Tricard More articles by this author Anne Mauger De Varennes More articles by this author Camille Haudebert More articles by this author Juliette Hascoet More articles by this author Nicolas Hubert More articles by this author Imad Bentellis More articles by this author Branwell Tibi More articles by this author Christian Saussine More articles by this author Jacques Hubert More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement PDF downloadLoading ...