Robot-Assisted Laparoscopic Transvesical Closure of a Vesicovaginal Fistula: First Report in a Teenage Girl

Abstract

Vesicovaginal fistula (VVF) is rare in children and is most commonly associated with retained vaginal foreign bodies. Surgical repair is technically demanding and carries a significant risk of recurrence, which has limited the application of minimally invasive approaches. We report the first pediatric case of robot-assisted laparoscopic transvesical repair of a VVF.

A 14-year-old girl presented with longstanding urinary incontinence, malodorous vaginal discharge, and recurrent urinary tract infections, since early childhood. Initial imaging revealed a 30-mm bladder stone. Cystoscopy identified a large infratrigonal VVF associated with the stone, which had formed around a retained plastic ring. The foreign body and stone were removed through a suprapubic cystotomy. As spontaneous fistula closure did not occur after 1 year, definitive repair was undertaken. A robot-assisted laparoscopic transvesical approach was performed following cystoscopic identification of the ureteral orifices and placement of bilateral double-J stents. The fistula was closed in two watertight layers, with separate closure of the vaginal and bladder defects using absorbable sutures (Video 1).

No intraoperative or postoperative complications occurred. The patient was discharged on postoperative day 2. At 1-year follow-up, she remained asymptomatic, with complete fistula closure, normal urinary continence, and normal uroflowmetry findings. Robot-assisted transvesical repair provides excellent visualization and precise suturing within the confined pelvic space, representing a promising minimally invasive option for the management of complex pediatric VVF.