Design: A case report

Setting: Pandit hospital and laparoscopy centre, Ahmednagar, India

Patients or Participants: A 50 year female with a history of total laparoscopic hysterectomy 6 weeks ago, presented with a complaint of urinary incontinence and continuous leakage of urine per vaginum

Interventions: Laparoscopic repair of ureterovaginal fistula and vesicovaginal fistula

Measurements and Main Results: On examination and CT urography, a 3 cm vesicovaginal fistula tract was identified, and the patient was scheduled for laparoscopic fistula repair.

Surgical procedure:

1. Cystoscopy was done, and the vesicovaginal fistulous tract was identified and stented. On attempting ureteric stenting on left side, the DJ stent came back into the bladder and stenting was unsuccessful.
2. We then proceeded with laparoscopy. Ureteric course was dissected on the left side till the bladder.
3. Dissection of the space of Retzius was done.
4. Intraoperatively, after performing cystotomy, it was found that there was a combined vesicovaginal with ureterovaginal fistula.
5. The vagina and bladder were defined; and a plane was created between them. The edges of the fistula were circumscribed and freshened, and a double-layered vaginal closure was performed.
6. cystotomy was then closed with barbed sutures and epiploicae interposition was done.
7. The bladder was mobilized from right side to achieve tension free anastomosis of the ureter.
8. For the UVF repair, the distal end of ureter was cut and spatulation of ureter was done.
9. A layered cystotomy was performed; followed by

Ureteric reimplantation and DJ stent placement i.e. Ureteroneocystotomy

Conclusion: The present case report highlights the feasibility and success of laparoscopic repair for treating ureterovaginal fistula and vesicovaginal fistula, and thus it can be considered as a viable treatment option for selected patients