Robotic management of urinary fistula

doi:10.1016/j.ajur.2023.11.002

Asian Journal of Urology, 2024, 11 (3): 357-365 doi: 10.1016/j.ajur.2023.11.002

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Robotic management of urinary fistula

Luis G. Medina^a,Randall A. Lee^a,b,Valeria Celis^a,Veronica Rodriguez^a,Jaime Poncel^a,Aref S. Sayegh^a,Rene Sotelo^a,*(

)

^aThe Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
^bDivision of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA

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Abstract

Objectives: To highlight critical preoperative and intraoperative considerations in approaching fistula repair robotically.

Methods: A search of the literature was conducted to identify relevant articles pertaining to robotic management of urinary fistulae.

Results: Fistulae of the genitourinary tract can be a challenging dilemma for urologists, as definitive management may require surgical intervention. Pathogenesis of both enteric and non-enteric fistulae are multifactorial, and successful repair hinges on the meticulous perioperative evaluation, planning, and execution. Traditional open techniques can subject patients to increased morbidity and prolonged hospitalizations. Since its introduction, the robotic surgical platform has continued to expand its indications. Its three-dimensional visualization and tremor free wristed instrument movements have made the robotic platform an attractive option for genitourinary fistula reconstruction.

Conclusion: Robotic management of complex urinary fistulae is feasible in expert hands; more studies are needed to define its role in the treatment algorithm of this devastating conditions.

Key words： Fistula Robotic surgery Rectourethral Rectovesical Vesicovaginal

Received: 06 June 2023 Available online: 20 July 2024

Corresponding Authors: *E-mail address: rene.sotelo@med.usc.edu (R. Sotelo).

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	Luis G. Medina
	Randall A. Lee
	Valeria Celis
	Veronica Rodriguez
	Jaime Poncel
	Aref S. Sayegh
	Rene Sotelo

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Cite this article:

Luis G. Medina,Randall A. Lee,Valeria Celis, et al. Robotic management of urinary fistula[J]. Asian Journal of Urology, 2024, 11(3): 357-365.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.11.002 OR http://www.ajurology.com/EN/Y2024/V11/I3/357

Cystoscopic view of a vesicovaginal fistula tract.

Port placement configuration.

Illustration showing the robotic system docked with the patient in Trendelenburg's position and another surgeon performing a cystoscopy for cases in which cannulation of the ureters or the fistulous tract is needed.

Cannulation of the fistulous tract and both ureters in preparation for a robotic surgical repair to aid with the intraoperative identification of these structures.

Retrovesical and transvesical approaches for vesicovaginal fistula repairs. (A) Retrovesical approach (between bladder and vagina); (B) Transvesical approach (cystotomy).

Transperineal urethral mobilization. (A) Perineal midline incision; (B) Urethral dissection and exposure; (C) Retrograde advancement of the urethra; (D) Vesicourethral anastomosis.

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