title: Cystohysteroscopy: novel use of semi-rigid ureteroscope to establish an access via fistulous tract between urinary bladder and vagina for confirming the diagnosis and facilitating laparoscopic repair of vesicouterine fistula.
abstract: In patients with vesicouterine fistula (VUF), identification of the fistulous tract during laparoscopic surgery remains difficult. Hysterography and intravesical instillation of dye have been the traditional methods for diagnosing VUF; now, they have been supplanted by ultrasonography, CT, and/or MRI. Unfortunately, none of the above mentioned investigations aid in identification of the fistulous tract during laparoscopic surgery or ease laparoscopic dissection. We describe a simple procedure, which we term cystohysteroscopy, that aids the diagnosis of VUF and also simplifies laparoscopic dissection. A guidewire/ureteral catheter is coiled in the uterine cavity through the fistulous tract with the help of a cystoscope. By cystohysteroscopy, this guidewire/ureteral catheter is pulled out through the vagina using a semirigid ureteroscope. The advantage of cystohysteroscopy is that the presence of the guidewire/ureteral catheter across the fistulous tract aids laparoscopic dissection even in the presence of fibrosis and can be used for traction/manipulation during dissection in the vesicouterine area. This is the first report in the literature depicting the use of a semirigid ureteroscope for the purpose of cystohysteroscopy.
authors.affiliation: Department of Urology, Chhatrapati Shahuji Maharaj Medical University (formerly King George's Medical University), Lucknow, India.
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Singh
authors.forename: Pallavi Aga
authors.initials: PA
authors.lastname: Mandhani
authors.forename: Seema
authors.initials: S
authors.lastname: Mehrotra
authors.forename: Rahul Janak
authors.initials: RJ
authors.lastname: Sinha
mesh_terms: D000328:Adult; D003558:Cystoscopy; D005260:Female; D005402:Fistula / Q000150:complications / Q000175:diagnosis*; D005471:Fluoroscopy; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D020709:Ureteroscopes; D001747:Urinary Bladder Fistula / Q000150:complications / Q000175:diagnosis*; D014591:Uterine Diseases / Q000150:complications / Q000175:diagnosis*; D014945:Wound Healing