Robot-Assisted Uterus-Sparing Repair of a Vesicouterine Fistula - Case Report and Review of Surgical Techniques

Sep 28, 2026

Uploaded by Noah

Robot-assisted, uterus-sparing repair of a vesicouterine fistula (VUF) is presented through a transperitoneal surgical video. A patient developed VUF after a cesarean section and presented 22 years later with persistent hematuria. The procedure used excision of the fistula tract, multilayer closure of uterus and bladder, and omental interposition. Follow-up cystography confirmed no defects or recurrence, and the patient remained asymptomatic postoperatively.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Abstract

Introduction and Hypothesis

Methods

Results

Conclusions

Introduction

Review of Similar Cases and Repair Techniques

Case Report

Conclusion

Supplementary Information

Funding and Declarations

International Urogynecology Journal (2025) 36:2543–2544 [https://doi.org/10.1007/s00192-025-06304-w](https://doi.org/10.1007/s00192-025-06304-w) Robot‑Assisted Uterus‑Sparing Repair of aVesicouterine Fistula 26 Years After Cesarean Section: A Case Report and Review of Surgical Techniques Fabien Romito1 · Chahin Achtari1 Received: 14 May 2025 / Accepted: 11 August 2025 / Published online: 8 October 2025 © The Author(s) 2025 Abstract Introduction and Hypothesis This video illustrates the surgical repair of a vesicouterine fistula (VUF) via a transperitoneal, robot-assisted, uterus-sparing approach. Methods In this video, we present a VUF that occurred after a cesarean section. The patient presented 22 years later with persistent hematuria. She underwent a uterus-sparing, robot-assisted repair via excision of the fistula tract. The uterus and bladder were closed in multiple layers with omental interposition. Results The patient tolerated the procedure well. A follow-up cystography confirmed the absence of defects or fistula recurrence. She has remained asymptomatic since the surgery. Conclusions Our video demonstrates the feasibility of vesicouterine fistula repair with uterine preservation using an exclusively robot-assisted transperitoneal approach with omental interposition, yielding excellent results. Keywords Robot-assisted · Fistula · Menouria · Youssef's syndrome Introduction Vesicouterine fistulas (VUFs) are abnormal communications between the uterus and the bladder, representing a rare subset of urogenital fistulas, accounting for 1% to 4% of cases [1–5] . The increasing global rate of cesarean sections has led to a rise in VUF incidence [3]. Clinically, VUFs present most commonly with cyclic hematuria (menouria), vaginal urinary leakage, or secondary infertility [6] . Although spontaneous closure is rare (approximately 5% of cases [1, 4]), most fistulas require surgical intervention. This video illustrates the robot-assisted, transperitoneal, uterus-sparing repair of a VUF, highlighting a minimally invasive approach with omental interposition, performed 26 years after the index cesarean section. Handling Editor: Chris Chong Editor in Chief: Kaven Baessler * Fabien Romito fabien.romito@chuv.ch 1 DFME, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland Review of Similar Cases and Repair Techniques The majority of VUFs are diagnosed within months or a few years after cesarean section, with delayed presentations, as in our case, being exceptionally rare [3, 7] . Youssef first described the classic presentation of cyclic hematuria in 1957 [6], whereas others reported variable intervals between cesarean delivery and fistula onset, ranging from months to over a decade [2, 5, 7] . Our case stands out, with a 26-year latency, one of the longest reported in the literature. Surgical approaches to VUF repair vary: • Transvaginal approach: suitable for small, low-lying fistulas but limited by access and visualization challenges [8] . • Transvesical–retroperitoneal approach (O'Connor technique): historically considered a standard for complex fistulas, allowing layered closure and omental interposition [9] . • Transperitoneal approach: offers optimal exposure, especially for high or complex fistulas [10] . The robotassisted technique has gained popularity for its enhanced dexterity, 3D visualization, and precision, particularly in challenging dissections [11] . Key principles of VUF repair include: – Complete excision of the fistulous tract – Tension-free multilayered closure of the bladder and uterus – Interposition of vascularized tissue (typically omentum) to reduce recurrence risk – Bladder drainage for 10–14 days postoperatively Our case aligns with these principles. Case Report A 48-year-old para 2 woman underwent a primary cesarean section in 1999, complicated by a postoperative hematoma requiring reoperation. A second cesarean section in 2004 revealed m

FAQs

What condition does the video address and why is it clinically important?

The video addresses vesicouterine fistula, an abnormal communication between the uterus and bladder. It is rare but is associated with symptoms such as cyclic hematuria, urinary leakage, and possible secondary infertility.

How was the patient evaluated before surgery in this case?

Cystoscopy identified a posterior bladder fistulous opening above the trigone. MRI confirmed a vesicouterine fistula after negative methylene blue testing.

Which surgical steps and reconstruction strategy were used for uterus-sparing repair?

The approach included adhesiolysis and dissection, excision of the fistulous tract, two-layer bladder closure with barbed sutures, two-layer uterine closure, and omental interposition to reduce recurrence risk.

Sep 28, 2026

Uploaded by Noah