Robot-assisted surgery can be used to successfully repair abnormal openings between the uterus and the bladder, according to a report by Ashok K. Hemal, M.D., a Wake Forest University Baptist Medical Center urologist who is the world's most experienced surgeon in the procedure.
The openings, known as vesicouterine fistulas, can be the result of cesarean section surgery as well as prolonged obstructed labor. The main symptoms are menstruation through the bladder, known as cyclical hematuria, with or without urinary incontinence.
In the June issue of Urologia Internationalis, Hemal, a professor of urology, reports on three patients whose fistulas were repaired with robot-assisted surgery, a minimally invasive option that requires only five small incisions. In one case, a hysterectomy was also performed in addition to repairing the fistula. Hemal has previously reported his experience using the technology to repair other types of fistulas.
"Robotic repair was successful in all cases with mean operative time of 175.5 minutes and all patients being discharged on the third day after surgery," said Hemal in an interview. "Robot-assisted surgery allows surgeons to offer a minimally invasive approach for a variety of reconstructive procedures."
Treatment for the vesicouterine fistulas depends on the size of the opening and the symptoms. Options include hormone treatment to shrink the uterus to its pre-pregnancy size and surgery to repair the opening. At one time, the only surgical option was to open the abdomen with a large incision. A newer approach is laparoscopic surgery, a minimally invasive approach in which procedures are performed through small incisions. This option has been shown to decrease pain, length of hospitalization and scarring and offers a quicker recovery, said Hemal.