Robot-Assisted Single-Stage Repair of a Uretero-Vesico-Vaginal Fistula

This report involves a 45-year-old female who developed continuous vaginal urinary leakage due to a right uretero-vesico-vaginal fistula (UVVF) following laparoscopic hysterectomy. Her history included sleeve gastrectomy and pancreatoduodenectomy, complicating repair due to adhesions and limited omental availability. Diagnostic workup involved contrast-enhanced CT, pelvic MRI, cystoscopy, and retrograde studies confirming distal ureteral defect and fistula. After 3 months of urinary diversion via percutaneous nephrostomy, a single-stage robotic-assisted repair was performed using a transperitoneal extravesical approach. The procedure included adhesiolysis, indocyanine green-guided ureteral mobilization and spatulation, fistula tract excision, two-layer closure of bladder and vaginal defects, extravesical ureteral reimplantation, and interposition of a vascularized peritoneal flap. The procedure lasted 75 min and resulted in minimal blood loss. Postoperative cystogram at 14 days showed no extravasation. At the 3 month follow-up, symptoms resolved completely, hydronephrosis resolved, and bladder capacity increased after botulinum toxin injections. This case illustrates the feasibility and advantages of robotic single-stage reconstruction for complex iatrogenic fistulae in high-risk patients.