[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-414339-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-414339-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","robot-assisted-uterus-sparing-repair-of-a-vesicouterine-fistula-case-report-and-review-of-surgical-techniques","Robot-Assisted Uterus-Sparing Repair of a Vesicouterine Fistula - Case Report and Review of Surgical Techniques","","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.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/robot-assisted-uterus-sparing-repair-of-a-vesicouterine-fistula-case-report-and-review-of-surgical-techniques/414339/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/robot-assisted-uterus-sparing-repair-of-a-vesicouterine-fistula-case-report-and-review-of-surgical-techniques/414339.png","ImageObject",300,407,{"name":42,"@type":43},"Noah","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What condition does the video address and why is it clinically important?","Question",{"text":63,"@type":64},"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.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the patient evaluated before surgery in this case?",{"text":68,"@type":64},"Cystoscopy identified a posterior bladder fistulous opening above the trigone. MRI confirmed a vesicouterine fistula after negative methylene blue testing.",{"name":70,"@type":61,"acceptedAnswer":71},"Which surgical steps and reconstruction strategy were used for uterus-sparing repair?",{"text":72,"@type":64},"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.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},414339,1790814700,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":97,"preview_page_count":4},8796095462418,"https://ap-avatar.wpscdn.com/avatar/80000253c1241d02b47?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778826106357471780","International Urogynecology Journal (2025) 36:2543–2544  \n[https://doi.org/10.1007/s00192-025-06304-w](https://doi.org/10.1007/s00192-025-06304-w)  \nRobot‑Assisted Uterus‑Sparing Repair of aVesicouterine Fistula 26 Years After Cesarean Section: A Case Report and Review of Surgical Techniques  \nFabien Romito1 · Chahin Achtari1  \nReceived: 14 May 2025 / Accepted: 11 August 2025 / Published online: 8 October 2025 © The Author(s) 2025  \nAbstract  \nIntroduction and Hypothesis This video illustrates the surgical repair of a vesicouterine fistula (VUF) via a transperitoneal, robot-assisted, uterus-sparing approach.  \nMethods 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.  \nResults 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.  \nConclusions 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.  \nKeywords Robot-assisted · Fistula · Menouria · Youssef's syndrome  \nIntroduction  \nVesicouterine 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.  \nThis 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.  \nHandling Editor: Chris Chong  \nEditor in Chief: Kaven Baessler  \n* Fabien Romito fabien.romito@chuv.ch  \n1 DFME, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland  \nReview of Similar Cases and Repair Techniques  \nThe 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.  \nSurgical approaches to VUF repair vary:  \n• Transvaginal approach: suitable for small, low-lying fistulas but limited by access and visualization challenges [8] .  \n• Transvesical–retroperitoneal approach (O'Connor technique): historically considered a standard for complex fistulas, allowing layered closure and omental interposition [9] .  \n• 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] .  \nKey principles of VUF repair include:  \n– Complete excision of the fistulous tract  \n– Tension-free multilayered closure of the bladder and uterus  \n– Interposition of vascularized tissue (typically omentum) to reduce recurrence risk  \n– Bladder drainage for 10–14 days postoperatively  \nOur case aligns with these principles.  \nCase Report  \nA 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","cbCailums1ZvVUiJ","https://ap.wps.com/l/cbCailums1ZvVUiJ","pdf",433560,"English","# Abstract\n## Introduction and Hypothesis\n## Methods\n## Results\n## Conclusions\n# Introduction\n## Review of Similar Cases and Repair Techniques\n# Case Report\n# Conclusion\n# Supplementary Information\n# Funding and Declarations","[{\"question\":\"What condition does the video address and why is it clinically important?\",\"answer\":\"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.\"},{\"question\":\"How was the patient evaluated before surgery in this case?\",\"answer\":\"Cystoscopy identified a posterior bladder fistulous opening above the trigone. MRI confirmed a vesicouterine fistula after negative methylene blue testing.\"},{\"question\":\"Which surgical steps and reconstruction strategy were used for uterus-sparing repair?\",\"answer\":\"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.\"}]","Robot-Assisted Uterus-Sparing Repair of a Vesicouterine Fistula - Case Report and Review of Surgical Techniques | PDF",1790597289]