SUFU 2019: Neobladder-Vaginal Fistula

Miami, FL (UroToday.com) Dr. Zimmern demonstrates a case of a 56-year-old female with a history of bladder cancer who previously underwent radical cystectomy and neobladder. She then developed a large neobladder to vaginal fistula that as demonstrated on a CT cystogram. The patient was taken to the operating room and a standard approach like to treat a vesicovaginal fistula was taken. The fistula was intubated with a wire and a catheter was placed into the bladder and one into the fistula.

The fistula was then excised and closed in a standard manner. He did mention on the CT scan pre operatively there was a plane demonstrated. Once the fistula was closed an omental flap was identified and placed between the vaginal flap and the neobladder. A Foley catheter was left in the bladder afterward. The patient was able to pass a trial of void successfully.

Audience questions were then taken.  Dr. Blavais asked about difficult reach high fistulas and Dr. Zimmern recommends placing the patient is a steep Trendelenburg and using a long tip bovie.  Although this was not a radiation fistula, an inverted T flap was recommended by another attendee.

Dr. Zimmern mentions if there was no omentum available for the flap he could bring down a Martius flap.

In summary, Dr. Zimmern’s approach to a non-radiated neobladder vaginal fistula used the same principles as a vesicovaginal fistula repair. 

Presented by: Philippe E. Zimmern, MD, FACS, FPMRS, Professor in the Department of Urology at UT Southwestern Medical Center and Director of the Bladder and Incontinence Treatment Center

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