title: A retrovesical approach for the laparoscopic repair of vesicouterine fistulas.
abstract: OBJECTIVE
  To report the initial experience with laparoscopic repair of vesicouterine fistulas (VUFs) at Shiraz University of Medical Sciences, Shiraz, Iran.
  
  
  METHODS
  Between June 2012 and February 2013, 2 patients with a history of multiple cesarean deliveries had a diagnosis of VUF confirmed by cystography and cystoscopy. The fistulas were repaired laparoscopically via a retrovesical approach to minimize manipulation of the bladder.
  
  
  RESULTS
  The operative times were 160minutes and 180minutes. Excellent laparoscopic visualization and magnification together with the presence of a catheter in the fistula tract allowed meticulous dissection in the retrovesical space between the bladder and the uterus, and resection of the fistula tract with minimal manipulation of the bladder, obviating the need for a large cystotomy. A postoperative cystogram at 4weeks showed complete resolution of the VUF in both patients. There was no recurrence of the fistula and the patients remained symptom-free during the follow-up period.
  
  
  CONCLUSIONS
  Laparoscopic VUF repair with a retrovesical approach is an effective technique with successful outcome. This approach provides excellent exposure to a poorly accessible area in the retrovesical space. Longer follow-up periods are needed to evaluate the likelihood of VUF recurrence with this technique.
authors.affiliation: Department of Urology, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: aminsharifi_ar@yahoo.com.
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.affiliation: Department of Urology, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Afsar
authors.affiliation: Department of Urology, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohamad K
authors.initials: MK
authors.lastname: Shirazi
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D005402:Fistula / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000601:surgery*; D014591:Uterine Diseases / Q000601:surgery*; D014945:Wound Healing
keywords: Cesarean delivery; Genitourinary fistula; Laparoscopy; Vesicouterine fistula