Incontinencia urinaria poscesárea: abordaje laparoscópico extravesical para la reparación de fístula vesicouterina. Reporte de caso de caso y breve revisión de la literatura

Case description: We report the case of a 35-year-old female patient who presented intermittent urinary incontinence three weeks after cesarean section. Vesicouterine fistula was diagnosed. Preoperative studies included clinical history, voiding cystogram, contrast tomography, and cystoscopy. An extravesical transperitoneal laparoscopic approach was performed and the vesicouterine fistula was closed. During the approach, cystoscopy, bilateral ureteral catheterization, trocar placement, adherensiolysis, bladder and cervix separation, hysterectomy, vaginal vault and bladder closure, and omentum interposition were performed. Blood loss was minimal and the patient was discharged 24 hours later. Relevance: Vesicouterine fistulas are among the least common urogynecologic fistulas, however, their incidence increases in parallel with the number of lower segment cesarean sections worldwide. Clinical implications: The usual treatment has been open abdominal repair. Urinary incontinence that occurs after an obstetric event should suggest the presence of some surgical complication. It is important to know the different surgical approaches for its resolution. Laparoscopic repair of vesicouterine fistula is safe and effective. Conclusions: This approach is an excellent minimally invasive option in hospitals where robotic technology is not available. The experience of the surgical team is essential in the management of these cases.