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Vesico-Vaginal Fistula Repair Using Pneumovesicoscopy: A Single Tertiary Care Center Study
Sunirmal Choudhury1, Malay Kumar Bera1, Rajat Nandy2
1Department of Urology, Medical College and Hospital Kolkata, 88, College Street, Kolkata, 700073, India.
Introduction And Hypothesis:
Vesico-vaginal fistula (VVF) is an abnormal bladder-vagina communication causing continuous urinary incontinence. This prospective study compares the efficiency and outcomes of pneumovesicoscopy (PV) versus laparoscopy (LA) for repairing simple to intermediate fistulas.
Methods:
Fifty female patients, primarily with iatrogenic simple and intermediate VVF following hysterectomy, were assigned to either the PV group (N = 25) or the LA group (N = 25) at a tertiary care center in India. Evaluated outcomes included operative time, blood loss, hospital stay length, and success rates, defined by a negative two-swab test at follow-up.
Results:
The PV group demonstrated significant advantages, including a shorter mean operative time (110.5 ± 25.1 min vs. 175.8 ± 38.7 min, p < 0.001) and lower estimated blood loss (25.1 ± 8.3 mL vs. 40.2 ± 12.5 mL, p < 0.001). Additionally, mean hospital stays were significantly shorter for PV patients (2.1 ± 0.7 days vs. 4.5 ± 1.2 days, p < 0.001). At 3 months, success rates were comparable between the groups, with 88% for PV and 84% for LA (p = 0.500). Complication rates were lower in the PV group (12%) compared to the LA group (28%).
Conclusion:
Pneumovesicoscopy is a feasible, safe, and effective minimally invasive technique for VVF repair. It provides shorter operative times, reduced blood loss, and quicker recovery while maintaining success rates equivalent to conventional laparoscopy.