V7-07: Pediatric Laparoscopic Congenital Vesico-vaginal Fistula Repair for Vaginal Agenesis
The role of minimally-invasive surgery in pediatric urology has markedly expanded, but has not been traditionally applied to vesico-vaginal fistulae repairs in children. The current technique is feasible as an alternative approach and demonstrates the versatility of laparoscopy in reconstructive urology.
The patient is a 15 year-old post-menarchal female with uterus didelphys, bilateral hematocolpos, distal partial vaginal agenesis and a vesico-vaginal fistula diagnosed on both clinical examination and MRI. She initially presented with urinary retention and a history of cyclical, recurrent menouria. The procedure began with cystoscopy, vaginoscopy, and bilateral ureteral catheterization. The fistula was clearly identified endoscopically. The patient then underwent laparoscopic vesico-vaginal fistula repair and repair of the distal partial vaginal agenesis with buccal mucosal vaginal reconstruction.
The patient tolerated the procedure well. There were no complications. The patient was discharged on postoperative day 2 in stable condition. In follow-up, the patient was voiding well with a well-healed buccal mucosal graft and excellent cosmetic outcome.
Laparoscopic vesico-vaginal fistula repair is a safe and viable option for children with vesico-vaginal fistulae. The mobilization attained laparoscopically facilitated the vaginoplasty by minimizing the defect gap to be bridged with buccal mucosa. The procedure also avoids the morbidity associated with a larger abdominal incision. The procedure offers benefits associated with minimally-invasive surgery: improved cosmesis, less pain and morbidity, and a potentially rapid recovery.