title: Laparoscopic treatment of genitourinary fistulae.
abstract: We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical  fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this  condition;  they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success  rate (7-12%) has been reported. Ureterovaginal  fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy,  patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails.  Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically  presents in  three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting  symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may  develop  in patients  with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate  procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of  a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and  parenteral  nutrition is  often initially attempted but these measures often fail. Timing of repair is often individualized mainly according to the etiology, delay of diagnosis, size of  fistula, the first or subsequent repairs, and the general condition of the patient. Different surgical techniques for the management of RUF have been reported.  Encouraged by our experience in minimally invasive  surgery we present the laparoscopic approach.
authors.affiliation: Robotic and Minimal Invasive Surgery Center, CIMI, Caracas, Venezuela. robertogc2@gmail.com
authors.forename: Roberto
authors.initials: R
authors.lastname: Garza Cortés
authors.forename: Rafael
authors.initials: R
authors.lastname: Clavijo
authors.forename: Rene
authors.initials: R
authors.lastname: Sotelo
mesh_terms: D053715:Cystotomy; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011182:Postoperative Care; D012006:Rectovaginal Fistula / Q000601:surgery; D014515:Ureteral Diseases / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000601:surgery; D014548:Urinary Fistula / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery; D014624:Vaginal Fistula / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000175:diagnosis / Q000601:surgery*