Hindawi Publishing Corporation Diagnostic and Therapeutic Endoscopy Volume 2010, Article ID 760348, 4 pages doi:10.1155/2010/760348 Research Article Transvesicoscopic Repair of Vesicovaginal Fistula R. B. Nerli and Mallikarjun Reddy Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital, Belgaum 590010, India Correspondence should be addressed to R. B. Nerli, rajendranerli@yahoo.in Received 2 September 2009; Accepted 23 November 2009 Academic Editor: Pedro F. Escobar Copyright © 2010 R. B. Nerli and M. Reddy. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Vesicovaginal ﬁstula has been a social and surgical problem for centuries. Many surgical techniques have been developed to correct this abnormality, including transabdominal, transvaginal, and endoscopic approaches. The best approach is probably the one with which the surgeon feels most experienced and comfortable. Laparoscopy has become increasingly popular in urology, reducing the invasiveness of treatment and shortening the period of convalescence. We report our results of transvesicoscopic approach for VVF repair. Materials and Methods. Patients with VVF were oﬀered repair using the transvesicoscopic route. With the patient under general anaesthesia and in modiﬁed lithotomy position cystoscopy was performed with gas insuﬄation. Under cystoscopic guidance the bladder was ﬁxed to anterior abdominal wall and ports inserted into the bladder. The ﬁstula was repaired under endoscopic vision. Results. Four women, who had VVF following abdominal hysterectomy, underwent this procedure. The operating time ranged from 175 to 235 minutes. There was minimal bleeding. Post operative complications included ileus in one and fever in another. No recurrence of VVF was noted in any patient. Conclusions. Transvesicoscopic repair of VVF is feasible, safe, and results in lower morbidity and quicker recovery time. 1. Introduction Vesicovaginal ﬁstulas present a debilitating and stressful condition for women in all parts of the world. Surgical repair remains the primary method of treatment, regardless of the etiology. Controversies still exist regarding the timing and surgical approach of Vesicovaginal ﬁstulas repair. The goal of treatment of Vesicovaginal ﬁstula (VVF) is the rapid cessation of urine leakage with return of normal and complete urinary and genital function. It has been stated that the best opportunity to achieve successful repair of VVF is with the initial operation [1]. Previous failed attempts at repair produce scar and anatomic distortion and may compromise potential reconstructive ﬂaps. There is no best approach for all patients with VVF. Classically VVF has been repaired through a transvaginal or transabdominal approach. Each approach has merits, depending on the par- ticular circumstances of the ﬁstula, and excellent outcomes can be expected with both approaches [2]. Laparoscopic approaches to VVF have been reported [3–5]. Surgeons using laparoscopic approach claim several advantages of laparoscopic repair such as shorter hospital stay, more rapid postoperative recovery; and better cosmetic results than the traditional abdominal approach. Laparoscopy allows an excellent view and good exposure of pelvic structures and provides quick and direct access to the ﬁstula, and relatively simple ﬁstula resection [6]. We report our series of VVF treated by transvesicoscopic approach. 2. Materials and Methods Patients with VVF formed the study group. A detailed history and examination was done in all patients. A three- swab test was done to conﬁrm the clinical suspicion. A routine ultrasonography of kidney, ureters, and bladder region was done in all. Imaging studies included Cystograms, Intravenous urogram, Magnetic resonance imaging when felt necessary and appropriate. Cystoscopy was done to identify the ﬁstula and note its size, position, and sorroundings. At the same instance vaginoscopy was done to observe the end of the ﬁstula. VVF repair was performed at least 12 weeks after its occurrence.