Combined vaginoscopy-cystoscopy: a novel simultaneous approach improving vesicovaginal fistula evaluation

Using a device that permits simultaneous viewing on the same display (picture in picture) of 2 images we performed combined vaginoscopy-cystoscopy (CVC) during evaluation for vesicovaginal fistula as a means of better visualization, allowing more precise identification and better preoperative planning.

A regular cystoscope and a 10 mm 0-degree laparoscope were used. Each was attached to a different microcamera and light source. The cameras were hooked to the back of a Twinvideo (Karl Storz Endoscopy, Tuttlingen, Germany), allowing a wide variety of views combining the 2 images. Cystoscopy was performed as usual and the laparoscope was used for vaginoscopy with a transparent vaginal speculum to maintain the vagina open, while allowing visualization of the vaginal wall. The 2 images were combined in picture in picture, providing confidence during the fistula identification process. Urinary leakage was viewed simultaneously with guide wire passage through the cystoscope and vaginal wall, showing the exactly fistula position.

The CVC procedure using 2 images in picture in picture allows precise identification during evaluation for vesicovaginal fistula.

CVC has become a routine procedure in suspicious cases or in those of a confirmed diagnosis of vesicovaginal fistula at our institution. It increases the likelihood of fistula diagnosis and identification, allowing better surgical planning.