Robotic vesico-vaginal fistula repair with bovine Pericardial Patch interposition

Giorgio Pomara1, Lorenzo Tesi1, Ramona Baldesi1, Michele Santarsieri1, Francesco Francesca1
  • 1 AOUP, U.O.Urologia II (Pisa)


A vesico-vaginal fistula (VVF) is a fistulous tract that connects bladder and vagina, causing
urine leakage via the vagina. Iatrogenic postoperative VVF is the most common case.
Classically, when treating a VVF via the abdominal route, an abdominal flap is mobilized and interposed between the bladder and the vagina. In our video, we describe a robotic VVF repair technique with bovine Pericardial Patch interposition instead of omental flap for a vaginal vault-located fistula. Duration of surgery was 115 min, estimated blood loss was <50 ml. The postoperative course was uneventful. At 40 days follow-up, which included clinical and cystographic examinations, the patient had not experienced any recurrence. In our opinion bovine Pericardial Patch interposition after a V-lock suturing technique using continuous sutures for vaginal closure and for perpendicular bladder closure is a safety procedure alternative to omental flap, reducing operating time and possible complications related to accidental peritoneal injuries.