Vesicovaginal fistula (VVaF) is an abnormal connection between the vagina and the bladder that conditions a constant flow of urine into the vagina. In well-resourced countries, VVaFs are relatively uncommon and more than 90% of cases are secondary to surgery or radiotherapy (RT). Surgical repair of VVaF has been the gold standard over the years. Both a vaginal and a transabdominal approach can be performed with good cure rates (around 90%)(1). Furthermore, since its description in 1994 by Nezhat et al, the laparoscopic approach is increasingly common in fistula repair, having demonstrated together with the robotic-assisted approach, very high cure rates (over 95%)(2). There are two main techniques in the laparoscopic or robot-assisted repair of VVaFs. On one hand, we have the adaptation of the classic O'Connor transabdominal-transvesical technique during which a broad cystotomy is performed to identify the fistulous tract, that is surrounded and resected. On the other hand, we have the extravesical technique, which was first described in 1998 as a site-specific repair with laparoscopic dissection of the vesicovaginal space until the fistulous tract is identified. We aim to describe the surgery and the results of one extravesical laparoscopic fistula repair.

A case report strategy is performed, recording the surgery and editing the video to follow the ICS requirements. Informed consent has been obtained before surgery.

The surgery had been completed exitously. The patient was discharged after 4 days and the catheters were removed in day 14 after surgery. After 6 months the patient was satisfied with no urine leakage and with no genitourinary complaints.

Laparoscopic management of VVF is an excellent option in experienced hands.
Simple VVFs (single tract, far from ureteral orifices, no extensive fibrosis) are those optimal to be managed through an extravesical approach performing a site-specific repair.
Complex VVFs (multiple tracts, close to ureteral orifices, and/or extensive fibrosis) are probably best managed through a transvesical (modified O´Connor) approach.

De Ridder D, Browning A, Mourad S, Stanford E, Loposo M, Muleta M, et al. Fistula. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed: ICS – ICUD; 2017. p. 2143-202.
Bodner-Adler B, Hanzal E, Pablik E, Koelbl H, Bodner K. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis. PloS one. 2017;12(2):e0171554.